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Inspire health. Serve with compassion. Be the difference. Job Summary Responsible for assisting in the execution of the annual Quality Coding Assurance Plan. Assists in conducting project planning and developing appropriate audit procedures and conducts audit procedures and reports findings. Coordinates efforts between the Office of Corporate Integrity and Physician Practices of the University Medical Group Administration to improve medical record documentation and overall compliance rates.
Essential Functions
All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference. Independently conducts all project planning procedures for low, moderate and high complexity audits. (Such procedures include determining project scope and objectives, identifying controls, determining "what can go wrong" in a process, and developing appropriate audit procedures to assess controls and address identified risks). Conducts random reviews of coded professional services in accordance with the Prisma Health Quality Coding Assurance Program. Reviews patient medical records and procedures performed in all patient care areas to ensure all policies relating to documentation are followed uniformly. Analyzes results to assess compliance with regulations, identifies procedural weaknesses and education needs that contribute to instances for non-compliance. Ensures that proper billings are issued from individual patient medical records and that all items are justified with proper supporting documents. Report documents findings in well-organized paperwork. Communicates findings and co-develops corrective action plans for the strengthening of internal controls with management of the audited area. Prepares formal written reports summarizing current state (findings), desired future state, and critical success factors (recommendations). Reports are completely accurate, concise, organizationally fluent, and grammatically correct. ApplicablePrisma policies or federal/state/agency laws or regulations are referenced and explained. Findings are presented in order of importance and are meaningfully condensed and presented in the Executive Summary.Conducts closing meetings with all levels of management for projects of low-to-medium complexity and participates with a Coordinator directing, in closing meetings for highly complex projects. Exhibits confident and competent verbal communication skills. Concisely presents findings and recommended corrective action plans. Cites and summarizes applicable policies, laws or regulations. Continuously gains knowledge of CPT, ICD, HCPCS and business/industry/legislative issues relating to and impacting Quality Coding Audit and Compliance issues. Increases knowledge by working with Internal Audit, Corporate Compliance, CDI, and HIM to gain experience required for advancing self and the organization. Assists Coordinator in training other auditors and new staff members through leading projects and working together to complete projects. Performs other duties as assigned. Supervisory/Management Responsibilities
Minimum Requirements
In Lieu Of
Required Certifications, Registrations, Licenses
Knowledge, Skills and Abilities
Physician ICD-9/10 and CPT coding experience Evaluation and Management Auditing and Healthcare Compliance experience Microsoft Excel, PowerPoint andWord
Work Shift Location Prisma Health Corporate Office
Facility 7001 Corporate
Department 70019700 Compliance
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Prisma Health
Sep 14, 2024