General Summary:

Responsible for reviewing, analyzing, disseminating, and reporting data on chart audits as well as audit documentation requirements of services billed per pre-established criteria approved by the Director of Compliance. Responsible for the processing of Medicare and other insurance carrier audit requests, such as Performant Audits, Targeted Probe Reviews, Overpayment Recoupment Efforts. 

Assist Internal Auditors as needed. Assist Medical Offices for coding and claims as needed. 

Works under the Supervision of the Quality and Compliance Director

Principal Duties & Responsibilities:

Example of Essential Duties:

1. Audit medical records for data collection and format, coding documentation and content utilizing pre-established criteria. Meets with physicians to review audit results and makes needed recommendations.
2. Audit medical record for adherence to Toledo Clinic Electronic Medical Record policies and procedures, documentation of quality measures, treatment plans, patient follow-up, as well as federal and insurance guidelines.
3. Performs educational sessions with physicians as needed.
4. Creates educational programs for physicians and coding staff to maintain compliance education.
5. Maintain written or computerized log of all data collected.
6.  Assist in collating, analyzing, and preparation of written report for the

 Compliance Program under the direction of the manager(s).

1.  Assist and/or perform these audits on main campus and satellite locations.
2. Monitors and retains Internal Compliance accountability logs.

Other Essential Duties May Include (but are not limited to):

1. Assist with special projects/audits and/or education as requested.
2. Other duties as assigned.

Knowledge, Skills & Abilities Required:

Required:

- Minimum 5 years’ experience in Coding, Billing, and Auditing.

- Knowledge of computer software, HTML forms design, data base spreadsheets, and word processing. 

- Knowledge of medical records documentation policies and procedures.

- Knowledge of Medical coding documentation requirements.

- Knowledge of medical terminology.

- Requires travel during business hours, valid state driver’s license preferred.

- Consistently arrives at work, in professional attire, on time and completes all tasks within established time frame.

- Seeks appropriate tasks when primary tasks are completed and assists co-workers as needed.

- Demonstrates adaptability to expanded roles.

Education: Diploma, certificate, or degree in medical coding and auditing.

Preferred:

- CPC Certification