Education / Licensure / Certification:
Bachelor degree required. RHIA or RN
RN or RHIA
5-7 years working with Chart Audits in a medical environment. General knowledge of ICD and CPT coding systems.
Experience preferred in Health Information Management with electronic medical records;
EPIC experience preferred
KNOWLEDGE, SKILLS AND ABILITIES:
•Must possess strong analytical skills, good communications and organizational skills.
•Must have the ability to meet tight deadlines.
•Strong projects management skills.
•Ability to work independently.
Exerting up to 10 pounds of force occasionally (up to 1/3 of the time) and/or; a negligible amount of force frequently (1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Job are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
HEARING / VISION:
•Hear and differentiate low volume sounds in order to make judgments regarding actions needed
•Hear alarm bells, verbal conversations, telephone voices and normal volume sounds
•Close vision (clear vision at 20 inches or less)
•Distance vision (clear vision at 20 feet or more)
CONDITIONS OF EMPLOYMENT:
• Annual flu shot
• Annual TB test (if applicable to your job location)
• Annual CBL’s (Safety at Work and Corporate Compliance)
• Maintain licensure/certification/registry/listing without lapse (if applicable to your job)
Job Description: JOB SUMMARY:
The Government Audit Coordinator will oversee the Government Audit implementation and response team. Develop workflows, policies and procedures and the communication plan to prepare for audit requests, denials and appeals in accordance with our compliance plan. Evaluates and reports risk and develops workflow redesign if necessary.
MAJOR WORK ACTIVITIES:
Audit Request: Manages all requests received from government audit Payor/contractor. Ensure chart documentation has been reviewed before mailing to include cover letter pointing out medical necessity and admission screening documentation. Maintains copies of all documentation sent. Ensures documentation is mailed within the time frame. No exceptions. 20%
Appeals: Administers the appeal and denial process. Follows appeal and denial process through the entire 5 Levels of appeal until a resolution is made .Documents the outcome of each level of appeal. Completes workque in EPIC/electronic medical record to ensure accounts continue to process appropriately 20%
Documentation: Ensures required information is documented into the tracking system upon receipt of denial or request from Payor/Contractor. Identifying reason for denial or request and updates system until resolution is complete. Maintaining 100% accuracy. Collect, organize and interpret data for identification and prioritization of areas of risk. Maintaining and submitting reports timely. Performs concurrent documentation reviews of selected records to clarify conditions/diagnoses and procedures. Recognizing the need for additional documentation or clarification and secures the documentation from the appropriate person. Displays extensive knowledge of documentation standards required by licensing/regulatory agencies and documentation standards/guidelines relating to coding/billing. 20%
Reviews/Policy: Develops changes to organizational practice, policies and procedures as needed in response to audit issues. Coordinates reviews for audit testing to ensure established regulations and policies are met. Monitors and identify potential issues. Complies reports as a result of reviews. Remains current through education and participation with various organizations. 20%
Reporting: Reports to Compliance Officer and/or Administration information such as the likelihood of denial; dollar amount of account; any identified documentation issues and reports progress. Works with Revenue Cycle, HIM, Compliance, CFO and Legal Counsel on guidelines to follow audit responses and to ensure smooth workflow. 20%