Audit Clinical Data Coordinator

Lehigh Valley Health Network•Allentown, PA

3d•Onsite

About The Position

Works with all clinical audit teams, compliance department, and specific departments to maintain an organized and timely logging, gathering of documentation, tracking, and follow-up of all audits including recovery audit contractor and any third-party request activities. Follow-up and support data, manages the data and organization, and administrative needs to all clinical audit teams to help with reporting of data and identifying trends.

Requirements

High School Diploma/GED
3 years in a hospital or healthcare administrative secretarial or office management environment
Ability to handle multiple tasks, deadlines, and requests utilizing appropriate time-management skills.
Ability to organize and conduct effective reporting and communication to assist management in the analysis of RAC and other third-party request activities.
Computer skills and working knowledge of Microsoft Office and other computer-based applications in order to create and maintain spreadsheets, databases, and perform word processing functions.
Extensive skill in planning and maintaining composure under pressure while meeting multiple deadlines.
Skill in compiling, summarizing, and analyzing complex data, and evaluating information and drawing logical conclusions.

Nice To Haves

Associate’s Degree

Responsibilities

Analyze data of requested claims and applies critical analytic thinking to identify pre and post-pay audit trends and claim denial trends by facility location, payers, and services lines to prepare reports to reflect RAC audits, insurance, and third-party activities and claim denials.
Logs all audit and claim denial requests, review findings, and determinations into the audit and tracking data base and evaluate logging and tracking processes and log all claim denials.
Identify workflow road blocks and makes recommendations to management and software vendor.
Develops and maintains a productive client, staff, and management relationships through individual contacts, events, and group meetings.
Communicate the results of audit activities via written report and oral presentation to management.
Completes follow-up and closing of audits.
Creates educational materials on use of audit tracking software and provides ongoing training to staff.
Works, reviews, and files all mail coming in via fax/scanning/e-mail and assign to most appropriate work queues for the Audit Compliance and Data Coordinator team to work.
Coordinators sending of appeals via RightFax while creating a database of all appeals sent.
Assist clinical audit and follow-up teams with write-offs and assigned to management work queue.
Attend monthly insurance/payer vendor meetings to ensure up to date information on policy updates/billing updates/etc.
Maintains open communication with insurance/vendor representatives.