Auditor

• Independently review patient medical charts to assess whether the care provided may have contributed to the cause of death.
• Make initial determinations based on clinical findings and documentation.
• Forward reviewed charts to the broader Medical Management Team for further evaluation and action.
• Assists in the development of clinical medical record audit tools and processes.
• Conducts data analysis using Microsoft Excel.
• Coordinates, retrieves, and performs medical record audits to determine provider compliance with established AHCCCS standards for documentation.
• Monitors and tracks Corrective Active Plans (CAPs), in collaboration with the Manager, Supervisor or QM RN.
• Provides written documentation and Corrective Action Plans as directed by the Credentials Committee to providers when necessary.
• Reports potential risk or compliance issues identified in the audit process to the Manager/Supervisor of QM.
• Coordinates, collects data and prepares monthly provider profile data reports for the Credentialing Department.

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