Clinical Auditor

High Desert Medical Group•Lancaster, CA

5d•$21 - $28•Onsite

About The Position

High Desert Medical Group is seeking a full time Clinical Auditor for our Living Well Resource Center. The individual will be responsible for placing outreach calls to patients regarding preventative screening measures and open care gaps, providing excellent customers service to patients, staff, and providers, and identifying and communicating trends observed in the department. They will also enter orders for outstanding care gaps per standard orders procedures, follow up telephonically with members regarding member experience and outstanding care gaps, and assisting with additional projects as requested.

Requirements

High school graduate or equivalent.
Certified Medical Assistant (CMA) or Licensed Vocational Nurse (LVN) required.
Knowledge of anatomy and medical terminology.
PC knowledge of MS Office and Internet applications.
Excellent written and verbal communication skills.
Ability to handle and prioritize tasks to meet all given deadlines and productivity goals.
Ability to responsibly handle matters of a confidential nature, HIPAA compliant.
Ability to work in a multi-task, high-productive environment.
Exceptional customer service skills
Must be computer Literate- EHR experience a plus

Nice To Haves

Coding training education preferred.
Project management experience is preferred.
Bilingual English/Spanish Preferred

Responsibilities

Audit and centrally manage measures that require or would benefit from clinical outreach.
Maintain and update Star measures (FMC, COA-Functional Status and COA-Medication Review) timelines, outreach results, and bi-weekly status reporting.
Conduct telephone visits for members for completion of preventive health services.
Collaborate with Senior Wellness providers regarding clinical services rendered.
Travel locally within IPA network for meetings as needed.
Serve as single point of accountability for project execution and delivery.
Audit and upload medical record documentation for completion of documentation, focusing on outstanding Quality Measures and unreported Risk Adjustment (HCC) diagnoses.
Assist with scheduling so that all Senior Wellness visits are scheduled to capacity.
Utilize specific provider and HDMG appointment guidelines when booking appointments.
Place calls to confirm appointments as needed.
Answer clinical patient questions within scope of certification or license.
Promptly remove cancellations from EPM.
Create charts in EPM for all first-time patients.
Assist with Risk Adjustment Data Validation (RAD-V) audits as requested by HCC leadership.
Serve as an expert resource for q.HMO and assist with measures/coding training sessions given to clinic and IPA staff, and all primary care team providers as requested by management.
Assist with orientation of clinic and IPA staff, and all primary care team providers to reinforce to providers the necessity for thorough and accurate documentation.
Conduct routine meetings with assigned providers and office staff at regular intervals, as set by department leadership.
Contact providers and/or clinical staff members when necessary to clarify medical record documentation.
Attend required meetings and participate in committees as requested by management or administration of HDMG.
Enhance professional growth and development through in-service, educational programs and conferences.
Maintain a current center for Medicare and Medicaid Services Hierarchical Condition Category, herein referred to as CMS-HCC guideline reference.
Incorporate ICD-10 yearly updates by October 1 of each year.
Demonstrate care, concern and courtesy when interacting with all internal and external customers.
Display warm and pleasant personality while emphasizing tact, empathy and patience.
Display sensitivity to patient conditions when obtaining information, ensuring maximum confidentiality.
Maintain HIPAA compliance, observing HIPAA and HDMG guidelines to ensure patient privacy.
Perform general clerical duties that include, but are not limited to, keeping meeting minutes, requesting medical records, photocopying, faxing, mailing and filing as per management’s request.
Initiate and answer telephone calls utilizing proper phone etiquette (first name and location).
Create and modify documents using Microsoft Office.
Complete and distribute meeting minutes for meetings and conferences attended (after receiving leadership approval).
Notify leadership of any problems that arise that may affect departmental or HDMG goals.
Participate in additional assigned project-based work as needed.
Maintain open, mutually respectful relationships with leadership and co-workers.
Maintain reliable transportation.
Request mileage reimbursement in a timely fashion (monthly, at minimum) when needed.
Perform other duties as assigned.