AUDIT INTEGRITY--MEDICAL AUDITOR I

Description

Medical Record Auditor I will be responsible for assisting/ conducting audits of medical records, coding and billing information. The auditor will look at both departments inside the hospital, outside departments and physician records and billing. Auditors will put together informational reports of finding and relay the information to the appropriate source. Reporting will be generating to help track which providers, locations or target areas need to be audited. The medical auditor will assist in putting together appeals/ rebuttals for external auditing sources. Auditor should have audits completed within a timely manner that is set up with the supervisor/ manager. Auditor will be provided as education as directed by the Auditing Integrity Department manager.

1. Interprets progress notes, operative reports, discharge summaries, and charge documents to determine services provided and accurately assign CPT, ICD-10 and HCPCS coding to these services.
2. Contacts physicians through management regarding procedures and other services billed to ensure proper coding.
3. Responsible for reviewing patient logs and other reports of clinical activity to ensure billing is capture for all patients.
4. Monitors and follow up to ensure all services that can billed are captured and coded for billing and no charges are incorrectly charged.
5. Reviews all physician documentation to ensure compliance with the third party and regulatory guidelines.
6. Works in conjunction with the reimbursement staff to answer all inquiries regarding coding and billing for services.
7. Works in coordination with the other members of the business office as necessary.
8. Meets and exceeds the short and long term goals as established for the department.
9. Performs duties and job functions in accordance with the policies and procedures established for the department.
10. Reports to work, meetings and professional obligations on time.
11. Participates in administrative staff meetings and attends other meetings and seminars.
12. Assists in evaluation of reports, decisions and results of department in relation to established goals.
13. Recommends new approaches, policies and procedures to influence continuous improvement in the departments efficiency and services provided.
14. Takes ownership of special projects, researches data and follows through with detail action plans.
15. Actively participates in problem identification and resolution and coordinates resolution between the appropriate parties.
16. Performs other related duties as required and assigned.
17. Uses outcomes management computerized information systems to statistically analyze outcomes data including practice patterns.
18. Compiles data into reports for the manager or committee including and analysis of trends and patterns.
19. Fulfills internal and external requests for outcome data, including developing special reports.
20. Participates in presentations to educate staff on outcomes and plans of correction.
21. Collaborates with the clinical team to use outcomes data in education.
22. Helps train clinicians or other staff on new protocols

Qualifications

Education/Certification: High School Diploma or GED, Certified Professional Coding Certificate or Certified Professional Auditing Certificate

Experience: Minimum of 3 years of coding experience. Working knowledge of CPT, ICD-10-CM, ICD-10-PCS, HCPCS.

Equipment/Technology: Knowledge of Excel, Microsoft Word, Medical Practice management software, Auditing software

Language/Communication: Effective communication to gather information and relay findings. Employee should have good communication with supervisor/ manager to ensure projects are completed within the appropriate time frame.

Mathematical Skills: Basic understanding of math and concepts to calculate percents of accuracy and deficiencies.

Mental Capabilities: Can concentrate for long periods of time in order to complete assigned tasks with a better than average attention span in order to listen, read and remember verbal and written instructions. Can understand input from the supervisor and/or manager concerning errors and instructions.

Interpersonal: Ability to work well with others and follow directions

Performance: Must be able to handle conflict issues with both staff and providers. Hold oneself to high standards and professionalism while performing audits and providing education.