Governmental Audit & Medical Records Reviewer, LPN
About The Position
As a Governmental Audit Reviewer, the LPN reviews and defends clinical documentation for home health, hospice, LTACHs, and community-based services during governmental audits and pre- and post-payment reviews. The role supports the integrity of care, reimbursement, compliance, and organizational audit readiness by preparing precise responses and appeals to external payer reviews. The position applies standardized review processes, coordinates audit assignments and appeal deadlines, tracks documentation for Administrative Law Judge hearings, and keeps current on applicable regulations, industry standards, and internal policies. It collaborates across departments to communicate audit trends and support corrective action, and assists the Governmental Audit Supervisor with repayment processes and additional compliance audits.
Requirements
- Associate’s degree in Nursing.
- Current and unrestricted licensure as an LPN.
- At least 1 year of experience in hospice, LTACH, and/or home health care.
- Working knowledge of reimbursement and compliance regulations.
- Proficiency in Microsoft Office applications, including Word and Excel.
Nice To Haves
- Bachelor’s degree in Nursing.
- Experience auditing and analyzing clinical documentation.
- Demonstrated leadership qualities.
Responsibilities
- Review clinical documentation for Home Health, Hospice, LTACHs, and Community-Based Services in response to governmental audits, including ADRs, RACs, CERTs, and ZPICs.
- Ensure consistency in clinical reviews through standardized processes and high inter-rater reliability.
- Draft professional response letters and manage internal determinations for audit appeals.
- Coordinate and track appeal assignments, ensuring deadlines are met and documentation is prepared for Administrative Law Judge hearings.
- Maintain current knowledge of federal and state regulations, industry standards, and internal policies related to compliance and reimbursement.
- Collaborate across departments to minimize operational disruptions and communicate audit trends for corrective action.
- Support the Governmental Audit Supervisor with repayment processes and additional compliance audits.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase plan.
- 401(k) contribution, subject to eligibility requirements.
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What This Job Offers
Job Type
Full-time
Education Level
Associate degree
