Overview: Under the direction of the Mgr. of Audit, the IR ProFee Auditor
performs coding and/or clinical documentation integrity audits to ensure
compliance with Federal and State Regulations
· The reviewer will identify cases coded incorrectly and provide
feedback and supporting documentation for changes to the coder.
· Utilize only recognized official coding resources when performing
· Perform coding both concurrent, prebill and retrospective
according to auditing schedule.
· Audits for appropriate clinical documentation to support diagnosis
capture and to ensure the level of service rendered to all patients is
· Serves as an expert resource in reviewing all medical records in
support of consistent documentation for all payer types (i.e. CMS,
Medicare-Advantage, etc.) to ensure complete and accurate diagnosis capture,
coding and queries.
· Provides recommendations for improvement and suggestions for
better quality and compliance.
· Maintain productivity based on type of cases reviewed and quality
· Complete audits within established timeframes.
· Completion and follow through of all processes entailed in reviews
and client obligations utilizing reviewer’s own initiative.
· Reviewer to adhere to ‘Standard Terminology for Quality Reviewer
· Other duties as assigned
· Prepare and maintain a productivity log.
· Experience with remote auditing and associated software applications
· Experience with various Encoder, CAC and EHR software applications
· Proficiency with MS Word, Excel and Power Point
Direct Reports –
Travel – No
Budget Oversight – No