Mary Greeley Medical Center AUDIT SPECIALIST in Ames, Iowa
Under general supervision, assists primarily with the management of the audit process related to coding and clinical validation audits. The Audit Specialist will be responsible for receiving, tracking, and managing payor audit record requests and outcomes, while working effectively with the representatives of the Health Information Management Office, the Business Office, and the Quality Department.
Unit Specific Position Responsibilities
Function as a department and process liaison to manage all payor post-payment audit documentation requests and appeals.
Review, analyze, and interpret documents and information to make decisions within scope of job functions with minimal supervision.
Monitor, review, and record all audit accounts for categorization, level of appeal, and status.
Scan records and documents appropriately, prepare release of information, and submit records in accordance with requests.
Monitor deadlines and ensure proper documentation is provided in support of requests for record audits and/or appeals in the required time frame.
Monitor and update audit and levels of appeal findings in tracking system.
Responsible for assisting with audit and appeal process requirements, and if appropriate, compliance with state or federal audit processes.
Demonstrate effective interpersonal skills which foster a team approach to problem solving and ensure high degree of customer satisfaction.
Follow up with external auditors for response as needed.
Assist with running and preparing reports for audits, utilization management, and compliance as directed.
Assist in establishing and maintaining policies and procedures for audit and appeal activities.
Demonstrate service excellence by maintaining an organized, professional, and independent work ethic.
Assists with monitoring results and accurate entry of appeal findings including financial outcomes
Assists Patient Access and Care Coordinators as needed with communication to support documentation requests and utilization management authorizations
Performs other assigned duties.
Qualifications, Knowledge & Experience
Required Qualifications (Including any licensure, certification, education):
Two years of higher education and/or two years of work experience in a medical office or insurance company setting.
Equivalent combination of education and experience that would demonstrate the capability to perform the duties of the position.
Highschool diploma or GED
Required Knowledge, Skills & Experience:
Basic Medical Terminology
Familiarity with ICD-10 and CPT coding
Knowledge of third-party payer reimbursement
Ability to operate office equipment such as phone, copier, scanner, fax machine, calculator, and adding machine.
Skill in using Microsoft Outlook and other Microsoft related programs such as Word, Excel, and PowerPoint
Ability to manage time effectively to meet deadlines.
Ability to read, analyze, and interpret documents and information to make decisions within scope of job functions with minimal supervision.
Excellent verbal and written communication skills
Effective interpersonal skills which foster a team approach to problem solving and ensure high degree of customer satisfaction
Demonstrates service excellence by maintaining an organized, professional, independent work ethic
High level of professionalism in order to handle sensitive and confidential information.
Experience with an electronic healthcare record system
Preferred Knowledge, Skills & Experience:
Prior work experience with Epic preferred (HIM, clinical and financial)
Experience with a document management system, On Base preferred