Title: Data Quality Auditor
Location: Stockton, CA
Under minimal supervision, ensures accurate & appropriate documentation through local coaching & monitoring. In addition, provides documentation coaching to clinicians in the Outpatient Clinic & Emergency Department. Monitors success of coaching & training efforts through encounter audits, which ensure documentation meets requirements for diagnosis & E&M assignment, based on Official ICD-9-CM Documentation Guidelines.
Essential Functions:
- Using independent judgment & sensitivity, coach's individual physicians, reviewing their audit findings, making suggestions for documentation improvements & updating on changes to Federal & State government billing & coding guidelines
- Partners w/ Trainer in the development of future training that will address documentation risk areas identified through local & regional audits.
- Plans, schedules, & performs encounter audits to monitor performance & ensure lasting improvement.
- Encounter audits will be the primary monitoring tool used to identify operational & regulatory issues related to coding, documentation, & compliance requirements & to ensure complete & accurate data capture in compliance w/ Federal & State requirements
- Monitors corrective actions for audit review findings
- Serves as a local resource in meeting internal & external regulatory requirements (e.g., Centers for Medicare & Medicaid Service (CMS), National Committee for Quality Assurance (NCQA) and actively participates w/ local CMS (Center for Medicare/Medical Services) team to ensure local objectives are met & regional CMS compliance activities are supported.
- Works w/ medical center leadership to provide confidential audits & feedback on an 'as needed' basis
- Assists in the identification of operational processes that hinder encounter data capture
- Enters encounter audit results into regional audit database to support quality assurance process, regional analysis & regional training activities.
- Prepares &/or performs medical center auditing analysis &/or special projects as assigned.
- Partners w/ Data Quality Trainer & other local analytical workgroups to identify audit trends & risk areas based on audit findings & data analysis.
- Assists in developing & implementing policies & procedures / Compliance Audit Standards to ensure compliance w/ Federal, State, & other regulatory requirements
Qualifications:
Basic Qualifications:
- Significant experience coding (three or more years) based on Coding Clinical Guidelines for inpatient & outpatient.
- Bachelor's degree (Business Administration, Health Care, Public Health, Finance, Business Medical Records Technology) or equivalent experience
- Certification in one of the following: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC)
- Experience using PC applications such as MS Word, Excel, Access, and PowerPoint preferred
- Medical center operations or clinical experience preferred
- Demonstrated experience conducting Medical Record audits & ability to interpret & apply Federal & State regulations, coding & billing requirements.
- Demonstrated project management experience including design & implementation of audit plans
- Ability to provide feedback constructively and sensitively to providers & medical center leadership regarding federal & state coding, medical documentation & compliance guidelines, audit results & risk areas
- Ability to work w/ & maintain confidentiality of physician, patient, patient account & personnel data
- Strong interpersonal & excellent written, verbal & presentation skills
- Ability to work independently w/ minimal supervision
- Ability to work w/in a team environment
- Willingness to be flexible depending upon department &/or physician schedule needs.
- Ability to review analytical data & audit findings to identify documentation trends & other risk areas
- Ability to develop data requirements & work w/ analytical groups to extract, organize & analyze coded data
- Travel between Medical Center facilities may be required
- Must be able to work in a Labor/Management Partnership environment
++NOTE: Travel to all four facilities is required ++
