The Executive Revenue Assurance is a frontline audit role responsible for conducting day-to-day billing audits across assigned clinical areas, identifying discrepancies at the point of billing, and preventing revenue leakage before final claim submission. The incumbent is the primary interface between the audit function and clinical / nursing teams on the floor.
This is a detail-oriented, field-based role requiring a thorough understanding of hospital billing workflows, procedure coding, HIS systems, and clinical documentation standards.
Key Responsibilities
1. Daily Billing Audit Assigned Areas
Conduct daily billing audits for all active and discharged patient files within the assigned floor / ward / ICU area
Verify that all procedures, consumables, consultations, and monitoring charges are accurately billed and reflected in the HIS
Identify and flag discrepancies: missed billing, wrong procedure codes,
duplicate entries, missed cross-consultations, and unbilled services
Reconcile clinical documentation (nursing notes, procedure records, doctor orders) against the HIS bill to ensure charge capture accuracy
Submit daily audit reports to the Senior Manager with item-wise bifurcation of revenue loss prevented (RLP)
2. HIS Billing Verification
Cross-check Hospital Information System (HIS) entries for each patient against actual services rendered
Flag delayed billing, wrong payor mapping, incorrect package inclusion or exclusion, and missing add-on charges
Ensure all procedure charges are entered within defined TAT post-service delivery
Escalate HIS system errors, auto-billing failures, or missing charge triggers to the IT / HIS team via the reporting manager
3. Procedure & Code Verification
Verify that procedure codes are correctly applied for each clinical service