Facility: VIRTUAL-GA

Job Summary:

The Coordinator is responsible for the ongoing and proactive coordination of RAC, MAC, OIG and all governmental audits and appeals processes. Communicates directly with involved departments, including but not limited to Case Management, Coding, and Patient Financial Services. This position controls, tracks and manages the timely response to all governmental audit requests via automated tracking system. Responsible for creating reports which accurately depict all governmental audit activities including record requests, correspondence and outcomes. Assists the Hospital Coding Assurance Director with updating and maintaining the annual audit work plan. Analyzes audit data regularly and consistently to identify trends and report to Director. Works closely with auditing team members to ensure appropriate and timely appeal responses. Compiles monthly and quarterly reports for submission to upper management. Stays abreast of CMS rules and regulations regarding compliance with billing, coding and auditing. Utilizes Excel as a tool for reporting and record keeping. Utilizes PowerPoint as a tool for presentations. Under the direction of the Hospital Coding Assurance Director, this position may perform audits of medical records and claims in accordance with the annual Compliance Work Plan.

Core Responsibilities and Essential Functions:

Maintain audit tracking database.
- Input audit data into tracking software system
- Track and manage the timely response to all governmental audit requests
- Ensure that database information is accurate, and responses are timely
- Work with auditing teams for timeliness of appeal responses. Create and prepare reports to include:
- Monthly Directors Report
- Quarterly Compliance Committee Report
- Ad-Hoc Reports as Requested
- Trend Reporting Assists the Hospital Coding Assurance Director with updating and maintaining the annual audit work plan
- Work with auditing team to maintain accuracy of audit plan progress
- Update plan with information regarding completion of audits
- Update plan with issues identified during risk assessments Completes annual risk assessment
- Reviews OIG annual workplan, Medicaid Work Plan, PEPPER data, internal reporting etc. to identify areas of risk, and assist with the development of the annual WellStar Hospital Coding audit workplan
- Works with other auditor team members in focus areas to complete risk assessment Audit Medical Records for Coding and/or Medical Necessity
- Perform audits of medical records and claims in accordance with the annual Compliance Work Plan
- Audit claims for medical necessity

Required Minimum Education:

Associate's Degree from an accredited college Required or
in lieu of associates degree candidate must meet the minimum experience. Required

Required Minimum License(s) and Certification(s):
All certifications are required upon hire unless otherwise stated.

• Cert Prof Coder or Cert Prof Coder - Hospital OP or Cert Coding Spec or Cert Coding Spec - Phys Based or Reg Health Information Admin or Reg Health Information Tech

Additional License(s) and Certification(s):



Required Minimum Experience:

Minimum 5 years auditing and/or coding experience.
Required

Required Minimum Skills:

Must have excellent written and verbal communication skills and demonstrated ability to understand and communicate complicated coding and compliance concepts to others.
Must be able to multi-task, be flexible, and work independently.
Must have excellent organization skills to support a multi-hospital healthcare system and manage multiple projects.
Maintain a high degree of accuracy and attention to detail.
Ability to work well under little guidance.
Objective and detailed approach to problem solving.
Proficiency in Microsoft Word, Excel and Power Point is a must.
Good investigative and organizational skills.
Advance knowledge of medical terminology, CPT and ICD-10-CM and HCPCS coding as well as Medicare, Medicaid and commercial insurance policies and procedures.
Working knowledge of medical records procedures and of federal and state laws governing medical records privacy and release of information.
Skill in exercising initiative, judgment, and decision-making to achieve organization objectives.
Skill in establishing and maintaining effective working relationships with others.
Ability to maintain confidentially of sensitive information.