Hospice Physician Audit Reviewer (Remote)

VITAS Healthcare•Miramar, FL

1d•Remote

About The Position

The Hospice Physician Audit Reviewer will support external government record requests by preparing chart summaries and providing expert testimony at administrative hearings as needed. While this position is primarily remote, it involves travel to provider locations for in-person trainings and to partner with program support initiatives. The role requires reviewing patient documentation to assess hospice benefit appropriateness, including clinical history, functional status, symptoms, and changes in plans of care. The physician will examine certification/recertification worksheets, narratives, plans of care, and interdisciplinary team notes for consistency and support of hospice eligibility. In cases of inconsistencies or omissions, the physician will provide explanations or suggest corrections. A summary report will be prepared, focusing on documentation supporting hospice eligibility and any additional supportive documentation for appeals. The role may also involve referencing evidence-based guidelines or journal articles. If a claim denial explanation is provided, the physician will verify the denial code, identify discrepancies, address each denial reason with explanations and documentation, and determine if additional chart documents establish hospice appropriateness. Chart review notes should summarize findings without conflicting with daily progress notes, and new information must be supported by additional documentation. The position performs related duties as required, and employees may be assigned other job-related duties by their supervisor or management.

Requirements

Board eligible / certified in Hospice and Palliative Medicine, Family Medicine, Internal Medicine, or other related specialty.
Working knowledge of the principles of palliative medicine and symptom management.
Completion of designated application and verification of credentials and qualifications.
Licensed to practice medicine or osteopathy in the state in which the program is operating.
Experience supporting external government record requests by preparing chart summaries and expert testimony at administrative hearings.
Ability to review documentation and identify clinical history, physical findings, functional status, symptoms, and pertinent changes in plans of care that support hospice benefit appropriateness.
Ability to review certification/recertification worksheets and narratives, plans of care review, and interdisciplinary team notes.
Ability to provide explanation or suggest correction for inconsistencies or omissions in documentation.
Ability to prepare a summary outlining patient demographics, time of admission, course of care, disposition, and statement of eligibility, focusing on documentation supporting hospice eligibility and additional supportive documentation for appeals.
Ability to reference evidence-based guidelines or journal articles where appropriate.
Ability to verify claim denial codes for legitimacy.
Ability to identify discrepancies between claim review explanations and supporting documentation.
Ability to address each claim denial reason with necessary explanation and supportive documentation.
Ability to identify additional chart documents not included in the first submission that establish hospice appropriateness.
Ability to summarize findings in chart review notes without conflicting with daily progress notes.
Ability to support new information with additional documentation accessed from the chart.

Nice To Haves

Experience in preparing chart summaries and expert testimony at administrative hearings.

Responsibilities

Support external government record requests by preparing chart summaries.
Provide expert testimony at administrative hearings as needed.
Travel to provider locations to provide in-person trainings.
Partner with program support initiatives.
Review documentation to identify clinical history, physical findings, functional status, symptoms, and pertinent changes in plans of care that support hospice benefit appropriateness.
Review certification/recertification worksheets and narratives, plans of care review, and interdisciplinary team notes to ensure they reflect and support hospice benefit appropriateness.
Provide explanation or suggest correction for inconsistencies or omissions in documentation.
Prepare a summary outlining patient demographics, time of admission, course of care, disposition, and statement of eligibility, focusing on documentation supporting hospice eligibility and additional supportive documentation for appeals.
Reference evidence-based guidelines or journal articles where appropriate.
Verify claim denial codes for legitimacy.
Identify discrepancies between claim review explanations and supporting documentation.
Address each claim denial reason with necessary explanation and supportive documentation.
Identify additional chart documents not included in the first submission that establish hospice appropriateness.
Summarize findings in chart review notes without conflicting with daily progress notes.
Support new information with additional documentation accessed from the chart.
Perform related duties as required.
Perform any other job-related duties assigned by their supervisor or management.