To be responsible to perform work auditing charts and tracking the status for Recovery Audit Contractors, federal and commercial. Identifies risks and trends, facilitates cross-departmental strategic and tactical actions.

PRINCIPAL DUTIES AND RESPONSIBILITIES(*Essential Functions)

1. Obtains, analyzes and coordinates audit information.


2. Tracks and trends issues found and develops action plans for areas of risk.


3. Tracks timelines of case requests, through the end result of the appeal process.


4. Tracks status of all Recovery Audit Contractor activity using an automated tracking system that provides appropriate documentation and data for internal and external reporting requirements.


5. Ensures compliance with State, Federal, CMS and OIG regulations relating to medical necessity, documentation, coding and billing.


6. Develops internal training programs to educate all departments and physicians on proper coding and billing as they relate to denial issues.


7. Coordinates all activities associated with reimbursement audits and appeals.


8. Communicates with all affected external entities involved in the reimbursement audit process.


9. Coordinates reports of reimbursement denial issues and shares results with the Director.


10. The results from the reimbursement audit are then reported to the committee and to corporate compliance.

JOB SPECIFICATIONS(Minimum Requirements)

KNOWLEDGE, SKILLS, AND ABILITIES


• Ability to work independently and in a team environment is required.


• Excellent verbal and written communication skills.

EDUCATION

• An Associates degree from a recognized college or university in Nursing and a current Registered Nurse licensure in the State of Indiana, or an Associates degree from a recognized college or university in health records management or a closely related field and RHIT credentials.


• Associates Health Information Required


• 5 years of hospital inpatient coding or clinical documentation specialist experience in an acute care setting.


• 5 Healthcare/Medical - Inpatient Coding Required

STANDARDS OF BEHAVIOR

Meets the Standards of Behavior as outlined in Personnel Policy and Procedure #1, Employee Relations Code.


CONFIDENTIALITY/HIPAA/CORPORATE COMPLIANCE

Demonstrates knowledge of procedures for protecting and maintaining security, confidentiality and integrity of employee, patient, family, organizational and other medical information. Understands and supports the commitment of Methodist Hospitals in adhering to federal, state and local laws, rules and regulations governing ethical business practices for healthcare providers.


DISCLAIMER - The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. The statements are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required.