Auditor I Job in Lakeland, Florida

Required Education and Experience: High School diploma or equivalent and one to two years coding/healthcare reimbursement experience. Certification by American Academy of Professional Coders (CPC). Must have basic knowledge in medical terminology and anatomy. Must have knowledge of insurance reimbursement, principles and practice. Must have knowledge of computer and Microsoft Office.   CRC (Certified Risk Coder) certification must be obtained within 6 months.  

Summary/Objective: Conduct Medical Compliance Review of Clinic providers for inpatient and outpatient claims.

Essential Functions
Conducts chart reviews of medical records for outpatient/inpatient providers. Reports on documentation to support CPT, ICD10, HCPCS and RAF reviews.

Provides timely provider communication by memo and telephone. Identifies deficiencies and educational needs of provider. Reports clear and detailed recommendations to improve documentation of E/M services, CPT, specificity of ICD10 codes and RAF scores.

Communicates credible and concise findings in provider reports. Presents in a professional, organized and positive manner.

Demonstrates a contribution to the department’s operation and goals/targets for the year. Maintains monthly log of activity, Completes a minimum of 10 charts/quarter for assigned providers. Prioritizes workload and maintains control over interruptions.

Demonstrates ability to use auditing software program, GE/IDX system, EPIC, and local hospital resources to conduct audit and summary of findings. Ability to use the TES program in GE/IDX for concurrent reviews. Pursues medical records needed from outside resources (i.e. SNF, other hospitals)

Identifies departmental process discrepancies during review process. Reports any operational areas of risks identified. Reports treatment inconsistencies for review.

Adheres to guidelines set by the Clinic’s Compliance Program and Audit policy and procedures