Full Time Medical Records Auditor - Skilled Nursing Facility

Avamere•Wilsonville, OR

8d•Onsite

About The Position

The primary purpose of the Medical Records Auditor is to appropriately and accurately verify and process requests for charts to be pulled for patient care, quality review, and audits in a timely manner. Accurately download, scan, and Index medical records for the appropriate chart. The person in this role is confident in accurate review of denials and findings and leads the investigation through collaboration with facility team members to find supportive evidence to appeal: this includes knowledge of clinical documentation requirements, the billing and payment system, ICD-10 coding, MDS, and CMS guidelines and regulations. Participate in the facility QAPI program providing data in an effort to identify opportunities and mitigate risks. Release information following all laws and regulations including HIPAA.

Requirements

Must have, as a minimum, three (3) years’ experience in a hospital, nursing care facility, or other related health care facility.
Must have working knowledge of MDS, coding, and clinical documentation standards.
Must have a working knowledge of managed care rules, regulations, and guidelines.
Basic computer knowledge
Must be a supportive team member, contribute to and be an example of teamwork and team concept.
Must be able to read, write, speak, and understand the English language.
Must possess the ability to make independent decisions when circumstances warrant such action.
Must be knowledgeable of nursing and medical practices and procedures, as well as laws, regulations, and guidelines that pertain to managed care and nursing care facilities.
Must be knowledgeable of billing requirements.
Must possess leadership ability and the willingness to work harmoniously with other personnel.
Must possess the ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, policies and procedures, etc., that are necessary for providing quality care.
Must have patience, tact, a cheerful disposition and enthusiasm.
Must be willing to stay on top of new and current regulations and coding guidelines and incorporate them into best practices.

Responsibilities

Appropriately and accurately pulls records for patient care, quality review, and audits in a timely manner.
Observe confidentiality and safeguards all patient related information.
Responsible for gathering and coordinating the release of medical information to insurance companies, state, and federal agencies
Collaborate with facilities and legal counsel following HIPAA 122P Medical Records Release Policy.
Verify authorizations in accordance with policy and procedure and state and federal laws.
Ensure that all requests for records are logged, and files are stored by organization file share processes.
Submit records timely using the method the requestor has in place (e.g. secure fax lines, secure portals, mail, etc.).
Request extensions if needed to gather all elements of the record prior to submission to avoid denials or findings.
Accurately review denials and findings and lead the investigation by collaborating with facility team members to find supportive evidence to appeal.
Notify the facility team immediately if elements are missing or if corrections need to be made in the chart.
Maintain a good working relationship within the department and other departments.
Participate in facility QAPI programs by tracking identified risks, opportunities for improvement, and successes identified through the ADR process.
Collaborate with billing to accurately track dollars at risk and dollars recouped through additional document requests (pre- or post-payment).
Agree not to disclose assigned user ID code and password for accessing resident/facility information and promptly report suspected or known violations of such disclosure to your supervisor.
Report any known or suspected unauthorized attempt to access facility’s information system.
Make appropriate reports to department supervisors as required or as may be necessary.
Follow the facility’s established procedures.
Report known or suspected incidents of fraud, waste and or abuse to your supervisor or the corporate compliance hotline.
Ensure that departmental computer workstations left unattended are properly logged off or the password protected automatic screensaver activates within established facility policy guidelines.
Participation in all compliance training programs.
Report suspected or known incidence of fraud relative to false billings, cost reports, kickbacks, etc.
Maintain the confidentiality of all resident care information including protected health information.
Report known or suspected incidents of unauthorized disclosure of such information.
Provide data to the Quality Assurance Committee as requested.
Participate in facility committees as requested.
Collaborate with team members as required.
Always represent the organization in a positive and professional manner.
Maintain regulatory requirements, including all state, federal, and local regulations.
Comply with all organizational policies and standards regarding ethical business practices.
Attend regular meetings and in-services, completing assigned training as required.
Perform other duties as assigned.