Audit Professional 2 - Health Information - FT Days

University of California, Irvine•Orange, CA

11d

About The Position

Incumbent is responsible for conducting both concurrent and retrospective audits of medical records to ensure the presence and timeliness of clinical information as defined by the Medical Staff General Rules and Regulations, Title 22, Medicare’s Conditions of Participation and Joint Commission requirements. Reviews records for evidence of documentation of medical necessity criteria in response to payment denials/chart requests from insurance companies. Compile’s data of the findings from the reviews and prepares reports for the Director for presentation at various committee meetings. Analyzes and identifies patterns and trends to identify opportunities for improvement. Participates in physician and other health care providers education to facilitate documentation within the medical record. Assists with the coordination of the forms committee to ensure forms content is compliant with outside regulatory requirements. Assists with other medical record related functions as required or assigned.

Requirements

Must possess the skill, knowledge and ability essential to the successful performance of assigned duties
Must demonstrate customer service skills appropriate to the job
Extensive knowledge of Joint Commission physician documentation requirements, Medicare’s Conditions of Participation, Title 22 documentation requirement and Medicare’s National and Local Coverage Determination Medical Necessity requirements for procedure performance
Excellent written and verbal communication skills in English
Demonstrated knowledge of medical terminology
Demonstrated experience with database information retrieval and analysis
Demonstrated ability to compare data from a variety of sources and accurately identify variances or discrepancies in the data
Attention to details with the ability to troubleshoot and pursue problems to satisfactory resolution
Analytical skills to identify problems, conduct research, analyze data and determine solutions
Advanced computer skills to include navigation and operation of MS office products (Word, Excel, PowerPoint, Access), with the ability to run various reports
Ability to understand and correctly interpret clinical documentation contained in an electronic medical record
Ability to maintain a work pace appropriate to the workload
Ability to establish and maintain effective working relationships across the Health System
5 years previous experience working with an electronic health record system
Must be able to provide proof of work authorization

Nice To Haves

Working knowledge of EPIC electronic health record.
Knowledge of University and medical center organizations, policies, procedures and forms

Responsibilities

Conducting concurrent and retrospective audits of medical records
Reviewing records for evidence of documentation of medical necessity criteria
Compiling data of the findings from the reviews
Preparing reports for the Director for presentation at various committee meetings
Analyzing and identifying patterns and trends to identify opportunities for improvement
Participating in physician and other health care providers education to facilitate documentation within the medical record
Assisting with the coordination of the forms committee
Assisting with other medical record related functions as required or assigned