COMPLIANCE AUDITOR-CLINICAL DOCUMENTATION

Sinai Chicago • Chicago, IL

1d

About The Position

The Compliance Auditor of Clinical Documentation Integrity at Sinai Chicago serves as a clinical consultant and subject-matter expert for clinicians and Patient Access staff. The role focuses on provider engagement and education in clinical documentation integrity, and on meeting monthly RCM cash collection targets by performing direct audits and correcting inefficiencies based on RCM benchmark KPIs. Additional clinical revenue cycle projects may involve Patient Access authorization denial management, coding optimization, CDI, HIM, organizational structure redesign, optimization, and centralization. Projects may require collaboration with teams outside the revenue cycle, including care management, utilization review, quality assurance, and population health, as directed by the Chief Revenue Officer, to prevent uncompensated care.

The position is responsible for the overall Patient Access financial and clinical transformational performance of remote and onsite CDI Specialists and Patient Access Management Staff. Functions include performance and process improvement, data trending and analytics to support decision-making, root-cause analysis, cross-department collaboration to course-correct, and development and monitoring of data-driven KPIs to measure progress.

The role develops strategies and coordinates Revenue Cycle projects with leaders across areas including Accounts Receivable, Financial Clearance, HIM/Coding/Revenue Integrity, Patient Access, CDI, and Clinical Operations. It develops and executes CDI and PFS quality and process improvement plans, identifies root causes, communicates issues for escalation, and works with Revenue Cycle partners to resolve recurring patterns and workflow or process issues. The role also creates and consolidates structures with monitoring and develops a methodology and committee structure to manage Revenue Cycle performance and govern operational changes intended to prevent future losses.

Requirements

• A minimum of 12 years of experience in Patient Accounts, Patient Access, and CDI within a healthcare setting is required in lieu of a degree.
• Experience facilitating the formal exchange and delivery of information among all levels within a provider organization and with executive leaders.
• Exceptional subject-matter knowledge of acute care and professional billing clinical documentation.
• Willingness and ability to learn and expand clinical and PFS knowledge to keep professional and organizational practices current.
• Certified Clinical Documentation Specialist (CCDS) credential required.
• Coding certification required: CIC, CCS, CMS, RHIA, or RHIT.

Nice To Haves

• Master’s degree preferred.
• LPN, RN, or Medical Doctor credential preferred.
• Billing and/or Patient Accounts certification, such as Epic Resolute or Billing Certificate, preferred.

Responsibilities

• Develop strategies and oversee and coordinate Revenue Cycle projects with leaders across key operational areas.
• Develop and execute CDI and PFS quality and process improvement plans that identify root causes and use proactive approaches.
• Identify issues and communicate them for escalation.
• Collaborate with Revenue Cycle partners to identify and systematically resolve recurring patterns, workflows, and processes.
• Create and consolidate structures with monitoring.
• Develop a methodology and committee structure to manage Revenue Cycle performance and govern operational changes intended to prevent future losses.
• Perform direct audits and address inefficiencies based on RCM benchmark KPIs to support monthly RCM cash collection targets.
• Provide provider engagement and education in clinical documentation integrity.
• Use data trending, analytics, root-cause analysis, and data-driven KPIs to guide decisions and measure progress.
• Collaborate across departments to course-correct and support Patient Access financial and clinical transformational performance.
• Collaborate with teams outside the revenue cycle, as needed and directed, to prevent uncompensated care.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed