Clinical Documentation Compliance Auditor

Promises Behavioral Health, LLC

18h

About The Position

The Clinical Documentation Compliance Auditor manages comprehensive medical record documentation preparedness for demonstrating compliance with regulatory, accreditation, and payor requirements; produces and maintains cumulative documentation compliance program activity records and analytical reports; tracks and trends documentation compliance program activities; ensures immediate availability of program integrity component documentation reviews; produces and manages quick reference guides to promote organizational awareness of documentation requirements; provides recommendations for improvement based on identified issues; and supports organizational accountability by producing and managing timelines to ensure issue closure and response deadlines are met.

Requirements

• Bachelor’s degree in social work, psychology, counseling, healthcare administration, or related field required.
• Minimum of four (4) years of progressively responsible and directly related experience.
• Ability to communicate effectively, demonstrating excellent verbal and written communication skills.
• Ability to plan, organize, and prioritize multiple tasks and work independently to meet deadlines and exercise sound professional judgment.
• Knowledge and general understanding of federal, state, payor, and accrediting body documentation compliance program requirements for behavioral healthcare organizations.
• Strong understanding of staff and client stakeholder requirements as they related to client medical records.
• Strong understanding of revenue cycle management stakeholder requirements, including connection between clinical workflow, utilization review workflows, and revenue cycle management workflows.
• Ability to evaluate the degree to which documentation matches payor clinical quality expectations, including appropriateness of interventions, ASAM application, LOCUS application, and use of evidence-based practice.
• Working understanding of facility operations and basic workflows.
• Ability to work effectively with individuals at all levels and with varying backgrounds both within and outside the organization
• Knowledge of and ability to use a personal computer and standard business software applications for word processing, spreadsheets, databases, presentations, and e-mail.
• Knowledge of and ability to use department-specific and enterprise computerized information systems to support compliance functions.

Nice To Haves

• Master’s Degree in social work, psychology, counseling, healthcare administration, or related field preferred.
• Clinical/Mental Health licensure preferred (e.g., LMSW, LCSW, LPC, LMFT).
• Experience in 24-hour non-hospital mental health and/or substance use disorder treatment settings strongly preferred.
• Experience in a utilization review or billing role preferred.

Responsibilities

• Maintain awareness of CMS Medicaid Integrity Program and “Documentation Matters” guidelines for behavioral healthcare practitioners
• Audit medical records, with a focus on meeting key regulatory and payor requirements, such as meeting required number of hours of services, completion of required sessions, and accurate data entry to assure appropriate billing.
• Organize and present audit data in a quantitative and meaningful way to support data analysis and decision making.
• As directed by the Chief Compliance Officer, investigate and maintain investigation documentation for, fraud/waste/abuse allegations related to medical record documentation.
• Research payor and regulatory medical record documentation requirements related to services offered.
• Develop educational materials and quick reference guides to promote organizational awareness of documentation requirements.
• When directed by the VP, Clinical Compliance and Quality Management, analyze workflows, and provide corrective action recommendations based on audit results.
• Provide project management support for corrective action plans, with a focus on supporting organizational accountability by producing and managing timelines to ensure issue closure and response deadlines are met.
• Understand the flow of information across software platforms as they relate to medical record documentation and associated billing, particularly the flow of information between electronic medical record and billing software.
• Annually identify specific needs for self-development and implement a plan to achieve professional growth.
• Participate in other projects as assigned and completes tasks within requested timeframes.
• Participates in periodic clinical compliance and quality program effectiveness evaluations.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 101-250 employees