Auditor

• Responsible for examining medical records, clinical documentation and claims to verify the accuracy and completeness of assigned codes.
• Responsible for identifying discrepancies, errors and inconsistencies in coding and billing practice. Including the potential of fraud, waste, and abuse (FWA).
• Ensures all federal and state regulations, Medicare and Medicaid rules and other payer guidelines are being followed
• Creates reports on identified errors and trends and recommends process improvements to management
• Collaborates with compliance, billing, clinical and clinical leadership to resolve any coding discrepancies.
• Responsible for maintaining a tracking system for all audits/requests activity throughout all levels of appeals.
• Researches new healthcare related questions as necessary to aid in investigations and stays abreast of current medical coding and billing issues, trends and changes in laws/regulations.
• Recommends possible interventions for loss control and risk avoidance based on the outcome of the investigation.
• Reviewing Chart Records to confirm accurate documentation to decrease audit concerns and documenting findings.
• Assisting our Compliance Officer with coding training documentation to better equip our providers
• Establishing workflows, policies and procedures, software analysis and maintenance and implementation of processes and communication plans for the facility's interactions with third party auditors
• Pre and post payment Medicare, Medicaid and commercial insurance reviews to ensure timely completion or review/audit documentation requests.
• Regular and predictable attendance is required.
• All other duties as assigned.

Revenue Cycle Management Coding Auditor

Senior Internal Auditor

Senior IT Internal Auditor

Agency Auditor

Senior Agency Auditor

Claims Auditor