Certified Professional Medical Auditor

 A Certified Professional Medical Auditor is responsible for reviewing and auditing medical documentation, including patient records, charts, and clinical notes, to ensure accuracy, compliance with regulations, and adherence to industry standards. This role is crucial in maintaining the integrity of medical records, billing processes, and healthcare facilities' compliance with applicable laws and regulations.

Key Responsibilities:

Medical Documentation Review:

Conduct thorough audits of patient medical records, including physician notes, progress notes, discharge summaries, and other relevant documentation.

Examine medical records to verify their completeness and conformity with established standards, ensuring they accurately reflect the patient's condition, diagnosis, treatment, and other pertinent information.

Verify that documentation adheres to established coding guidelines, such as ICD-10 and CPT, and compliance with healthcare regulations (e.g., HIPAA, Medicare, Medicaid).

Compliance Assessment:

Evaluate medical documentation for compliance with industry standards, hospital policies, and governmental regulations.

Assess policy adherence and procedural efficiency, upholding data integrity through audits and scrutinizing a range of medical documentation.

Identify and report any discrepancies or potential compliance issues, recommending corrective actions as needed.

Billing and Claims Audit:

Analyze medical claims data and associated documentation by conducting continuous auditing with analyses to prevent and address discrepancies and non-conformities in billing and provider chart documentation.

Evaluate coding and documentation to identify recommendations for provider improvement.

Document audit findings and suggest any applicable changes and/or opportunities for documentation improvement.

Recognize and identify trends in billing and documentation at both the practice and provider levels.

Education and Communication:

Assist in providing coding knowledge to providers and billing departments as needed.

Collaborate and communicate verbally and in writing to deliver audit findings, clearly articulating rationale supported by evidence of conclusions.

Knowledge and Compliance with Coding Standards:

Maintain current knowledge of CMS policies and coding applications for CPT, ICD-10, HCPCS, and other applicable coding standards for medical claims.

Compilation of applicable CMS fees and audit findings/results for tracking accuracy and provider productivity analysis.

Qualifications

• Certified as a CPMA
• 3 years of experience in healthcare
• Detailed oriented, attention to detail and ability to multi-task
• Good written and verbal communication skills