Clinical Auditor

Overview

UnityPoint Health is seeking a Clinical Auditor – Coding, Professional Billing to support and enhance documentation accuracy and coding practices across the organization.

This position will help develop and implement the education program aimed at enhancing documentation and coding practices across the organization. The Auditor will promote documentation accuracy by auditing and updating training tools for providers, clinical staff, coders and billing specialists. This role acts as a liaison between the providers, clinical staff and coders, provides updated and new materials, and helps answer documentation and coding questions.

Responsibilities

Clinical Documentation Review and Reporting

• Assess clinical documentation for compliance in accordance with the American Medical Association and the Centers for Medicare and Medicaid Services Coding and Documentation guidelines, regulations of federal and state agencies, and third party payers
• Validate clinical documentation in conjunction with charges and evaluate accuracy and timeliness of the billing process
• Investigate, evaluate and identify opportunities for improvement and provide guidance and counsel to providers with face-to-face meetings
• Identify and audit areas requiring attention, performing special audits/investigations as requested, share this information with leadership and provide one-on-one education with the provider and in a timely manner
• Collect and analyze data, submit reports as assigned and monitor monthly audits to ensure that they are completed timely
• Report/record all documentation and coding issues that require follow-up reviews to coding manager
• Work the EPIC follow-up and account work queues to keep queues in a manageable state; inform leadership of workflow issues with suggestions for improvement
• Be aware of what is happening in clinic/department and the organization by attending clinic/department meetings, reading e-mails/in-basket messages and regularly checking information on the organization’s intranet site
• Monitor environmental conditions in order to secure protected health information
• Demonstrate initiative to improve quality and customer service by striving to exceed customer expectations
• Balance team and individual responsibilities; be open and objective to other’s views; give and welcome feedback; contribute to positive team goals; and put the success of the team above own interests
• Perform other duties at the request of various departmental leadership groups to facilitate the smooth and effective operations of the organization

Clinical Coding Research and Education

• Participate in development and implementation of Office of Inspector General Work Plan
• Research coding inquires and be a resource for providers, clinical, billing and coding staff
• Monitor payment status of services with specific coding requirements as needed
• Maintain compliance with CLIA, OSHA, Safety and Risk Management guidelines
• Investigate, evaluate and identify opportunities for improvement and provide guidance and counsel to coding/billing staff by setting up small group meetings or training sessions
• Provide regular education to providers, clinical, billing and coding staff regarding coding documentation standards
• Help in updating the coding department’s newsletters, education, reference documents
• Be involved in coding team activities, partnering with other departments to capitalize on our FOCUS values