Audit Coordinator - Good Shepherd Rehabilitation Network

• JOB SUMMARY
  • Oversees and conducts the audit function for the upcoming RCD CMS Audit. Accurately identifies and diagnoses issues uncovered in audit process, identifies and evaluates alternatives to correct documentation, and effectively communicate results to relevant stakeholders in order to secure compliant documentation
• ESSENTIAL FUNCTIONS

  • COMPLETES MEDICAL RECORD AUDITS

    • Accesses and runs automated audit tool via facility’s EMR to determine elements out of compliance via standard work process.
    • Reviews documents for completion, guided by CMS rules and regulations.
  • COMMUNICATES AUDIT RESULTS
    • Communicates document compliance to appropriate providers and extenders of documentation status for compliance and improvement.
    • Upon record audit completion, sends records to manager to second level review and approval in a timely manner.
    • Communicates daily with Director of Revenue Compliance regarding audit progress, issues, other departmental work timelines, priorities, etc.
    • Communicates effectively with colleague stakeholders to inform them of potential issues identified and receive updated documentation that meets CMS standards.
  • SUBMITS/REPORTS/AUDIT RESULTS TO/FROM CMS
    • Prepares documents for initial upload and resubmissions to CMS via Novitasphere.
    • Manages daily communication of results and status with CMS and RCD team.
  • PROVIDES ADMINISTRATIVE SUPPORT
    • Manages and updates audit results via smartsheet tool.
    • When issues are identified, problem solves the reason and initiates solutions (communicating to providers, escalating to Director of Revenue Compliance, etc.) to a goal of 100% compliance of medical record files.
• QUALIFICATIONS:
  • To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
    
    • Education
      • Bachelors/Associates degree in clinical or health administration preferred.
      • Successful completion of medical and/or anatomical terminology courses required.
    • Work Experience
      • 2-3 years of medically related and administrative support is required.
      • Medical office/health information management experience with prior medical records auditing experience preferred.
      • Previous experience working with insurance companies, authorization, denials, appeals, peer to peer review, preferred.
      • Previous computer/data entry experience required – (ms-word, excel, ppt, and smartsheet).
      • Experience using EMR- Cerner/EPIC preferred.
      • Excellent communication skills required.
    • Licenses / Certifications
      • N/A

PI249181406