Auditor/Educator - NHMG Administration

About NHRMC NHRMC, established in 1967 in Wilmington, NC, is recognized as a preeminent healthcare organization focused on leading our community to outstanding health.
We have an 855 bed network of hospitals and multi-specialty physician group practices with more than 200 physicians.
With a network of primary, specialty, neighborhood clinics and regional medical centers; you will find our culture is the very definition of best in practice.
Join us and find out how many ways NHRMC offers you the chance to focus on what really matters - our patients and community.
About the Job Location: New Hanover Medical Group Department: NHMG Administration Full Time Equivalent: FTE: 1.
0 Work Schedule: 8HR DAY Exempt from Overtime: Exempt: Yes What You'll Do Summary: The team member’s Number One job responsibility is to deliver the most remarkable patient experience, in every dimension, every time, and understands how to contribute to the health system’s vision of achieving that commitment to patients and families.
At Novant Health, people are our business.
We treat each other with respect and compassion.
We embrace the differences in our strengths while fostering an environment of inclusion, empowerment, inspiration and courage.
The team member will use Novant Health’s First Do No Harm (NHFDNH) safety behaviors/error prevention tools and high reliability strategies as appropriate to ensure a safe, remarkable patient experience.
Responsible for conducting provider documentation audits to assess compliance with documentation, coding, and billing guidelines as established by Medicare, Medicaid, Tricare, and other payers as appropriate.
These guidelines may include, but are not limited to, inpatient and outpatient professional services, ancillary services (ex.
, labs, imaging), procedures (ex.
, injections, infusions, bariatric services), and ICD-10 diagnosis coding.
As part of these audits, the Auditor/Educator identifies trends, through both data analysis and documentation reviews, that may pose risks to individual providers, as well as to Novant Health and its affiliates.
The Auditor/Educator is responsible for creating summary documents detailing these risks and highlighting areas for overall documentation improvement.
Additionally, the Auditor/Educator is responsible for educating providers and other involved team members on results of the audits, either through individual or group training sessions.
The Auditor/Educator is expected to maintain or exceed established quality and productivity standards set by Compliance leadership.
This requires the ability to work independently, with minimum supervision.
The Auditor/Educator is also responsible for maintaining internal documents to support the Compliance audit function.
These internal documents are used for tracking, trending, and reporting, and require timely data entries.
The Auditor/Educator may also be asked to complete additional tasks as assigned by Compliance leadership.
Responsibilities: Essential Functions 1.
Audits: With minimal supervision, performs and documents provider audits.
Audits utilize a risk based approach incorporating data analytics, review of applicable payer coverage criteria, and application of coding and documentation guidelines and requirements.
Each provider documentation audit begins with provider specific data manipulation and examination to identify: types of services rendered, possible vendor relationships, use of ancillary team members to support documentation, high-risk outlier services, and relevant billing trends.
Based on the data analysis, the Auditor/Educator selects the audit sample and reviews the encounter in its entirety.
Work will be planned, performed, and documented using standardized department audit protocols and tools.
When necessary, collaborates with other team members to resolve questions or concerns regarding audit processes or interpreting guidelines and requirements.
Refers trends and systemic issues to Compliance Consultant team for further review.
2.
Education: Ability to absorb information and form appropriate conclusions, and apply general rules to specific problems and produce well-thought answers.
Utilize standard department templates to develop written summaries of audit results in a clear, concise manner.
Conducts meetings where audit result summaries are shared with impacted providers, whether individually or in a group setting.
Assist with and/or coordinate with other departments/clinics to ensure cohesive support of compliance functions.
Creates an environment that supports and respects diversity and inclusion in order to promote creative problem solving.
3.
Reporting: Maintains internal tracking documents to ensure data may be easily reported and extrapolated.
4.
Productivity: Meet established quality and productivity standards.
Productivity standards are based on a 40-hour work week; quality standards determined after quarterly reviews performed by an independent auditor.
5.
Professional: Read trade journals/book/articles related to compliance and auditing in areas of expertise.
Attend education/training events (internal and external).
Share knowledge with department and stakeholders.
Serve as a role model for ethical conduct, including the ability to convey a positive, professional image.
Position Requirements Credentials: Education: Essential: * High School Diploma Other information: Education: High School or GED required.
4 year/Bachelors degree preferred.
Graduate degree preferred.
Experience: 10+ years of experience is required if no 4 year degree.
If candidate has 4 year degree, 1 year of health care experience is preferred.
If candidate has a 4 year degree, 1 year of healthcare coding experience is preferred.
Refer to the Life Support Training Policy NH-HR-3096.
Licensure/certification: CHC, RHIA, RHIT, CPC, CRC (If no CPC certification, candidate is required to obtain within 6 months of hire date.
If no CRC, candidate is required to obtain within 1 year of hire date.
Additional Skills/Requirements (required) •Limited to intermediate knowledge, skills, and abilities regarding internal controls, and understanding operations as they interface with the area of expertise; •Limited to intermediate knowledge, skills, and abilities regarding clinical documentation, coding, and billing; •Basic to intermediate knowledge, skills, and abilities regarding analytical skills, listening, and writing; •Intermediate knowledge, skills, and abilities regarding presenting; •Limited to advanced knowledge, skills, and abilities regarding researching regulations and standards, reimbursement protocols, and compliance program requirements; and •Ability to drive/travel to multiple locations/facilities as needed.
Other Information This position description has been designed to indicate the general nature and level of work performed by employees within this classification.
It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications which may be required of the employee assigned to the position.
Depending on the location of the job, duties may vary.
Receipt of the job description does not imply nor create a promise of employment, nor an employment contract of any kind; my employment with the Company is at will.
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