The Clinical Auditor reports to the Internal Audit and Compliance Director and is responsible for ensuring clinical compliance. The Clinical Auditor collaborates directly with practitioners, staff auditors, and management. This position reviews clinical documentation in the medical record to ensure documentation supports medical necessity. He/she will independently manage multiple concurrent and retrospective audits and monitoring efforts, and related projects; makes judgments around objectives and scope of regulatory adherence and ensures effective and efficient audit execution. Responsibilities include: Ensures medical necessity and compliance with federal and state regulations, and organizational policy. Act as a clinical and documentation expert resource for the Audit team and management. Interact in a professional manner with all interdisciplinary team members working together to improve provider documentation, and billing codes including modifiers. Analyzes and monitors clinical documentation to identify trends and recommend improvements to quality. Communicates documentation issues clearly and succinctly, including prepared report of findings, and follow-up on action plans. Draft reports based on results of audit or other projects and work with management to develop their response to the audit observation and related recommendation. Leads audit-closing meeting with auditees by presenting the findings and related recommendations. Excellent time management and organization skills. Applicant must also be able to prioritize, manage multiple tasks, and have strong attention to detail. Demonstrates and motivates others in effective team coordination and cooperation. Tracks and report the status of audit projects. Adheres to HIPPA laws and maintains patient confidentiality at all times.
Qualifications: Bachelor's degree in Nursing. 5+ years' experience as a clinical nurse in an acute care or physician practice setting. Working knowledge of state and federal regulations, Medicare, Medicaid and third party payer requirements. Knowledge in reading and interpreting medical records and patient data. Knowledge of medical and surgical procedures and other healthcare related practices. Demonstrate proficiency with Microsoft Office Applications. Knowledge of EPIC software a plus.
EOE AA M/F/Vet/Disability