Chart Reviewer/Compliance Educator- Hansen
Job Description and Essential Functions
Job Title/Position: Chart Review/Compliance Educator
Job Classification: Administrative/Professional Support
Date of Analysis: 02/2019 Date of Revision/Review:
Brief Description of Job Responsibilities:
The Chart Review/Compliance Educator is responsible for performing annual, periodic, or other focused medical record audits as requested to oversee the quality and accuracy of provider
inpatient and outpatient documentation and coding. The position will also meet with individual and/or groups of providers to discuss documentation and coding recommendations, and educate them on policy and guidelines, as it applies to their review. The individual will serve as subject matter expert in applying the requirements of Prevea and CMS Policies. The position requires effective communication skills and excellent organization to ensure timeliness and accuracy of response to requests, as well as continual program development through training and process improvement. The individual will also support provider education by presenting documentation and coding guidelines during new provider orientation sessions, and meetings with those providers at regular intervals following their orientation to review individual progress. The position will also be knowledgeable in Epic navigation, from the provider perspective, to further assist with provider work flow.
(This list may not include all of the duties assigned)
- Present audit reports and results to management.
- Conduct internal audits of medical documentation to ensure the documentation adequately supports the providers service billed in compliance with the appropriate regulations and/or industry standards, as directed by Prevea`s Chart Review Policy.
- Develop and deliver education to new providers during their orientation process regarding compliant documentation and coding regulations and guidelines.
- Conduct audits on other compliance related topics as determined by the Compliance Director, Business Office Director and Coding Manager.
- Prepare written reports of the results of the audits, including recommendations for improvement and compliance with state and federal laws and regulations to include Prevea Health`s policies and bylaws.
- Plan and educate staff as required to meet compliance within regulatory guidelines and organizational policies.
- Develop, coordinate and deliver educational training programs/materials related to compliance, appropriate documentation and accurate/consistent coding.
- Develop individualized educational plans to improve provider accuracy where deficits are identified through internal or regulatory audits.
- Develop documents and assist in implementing policies and procedures to ensure compliance with state, federal and third-party requirements and to minimize corporate risk.
- Manage the post pay audit process.
- Knowledge of ICD-10 and CPT coding.
- Demonstrate interpersonal and team skills, the ability to communicate effectively orally and in writing.
- Ability to generate reports for management review that presents audit results in a clear manner.
- Ability to meet deadlines and respond well to frequent changes in regulation.
- Strong knowledge of corporate compliance programs.
- Skill, knowledge and ability essential to the successful performance of the job duties.
- Knowledge of anatomy and physiology, disease process and medical terminology.
- Ability to establish and maintain effective working relationships in the department and across the organization.
- Ability to work independently and be a self-starter.
- Must utilize strong interpersonal skills to focus on problem solving, listening objectively and openly to other`s ideas and contributing to the building a positive team environment.
- Ability to express oneself clearly, concisely and tactfully to establish effective working relationships with all employees of the organization and relevant external parties.
- Critical Thinking - Use logic and reason to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problem/issues.
- Must focus on continual quality and process improvement.
Non-Essential Duties: Other duties as assigned within scope of practice
Typical Working Conditions:
Work is performed in an office environment. Involves frequent contact with staff and providers. Work may be challenging at times.
Typical Physical Demands:
Requires prolonged sitting, some bending, stooping and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment. Requires corrected vision to 20/30 and hearing to normal range to record, prepare, and communicate appropriate reports. Ability to lift up to 30 pounds. Required to drive to meet with providers occasionally. Required to lift and carry briefcase with binders weighing approximately 20 pounds
In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United State and to complete the required employment eligibility document form upon hire. Prevea participates in E-verify. To learn more about E-Verify, including your rights and responsibilities, please visit www.dhs.gov/E-Verify
Essential Functions/Physical Demands
Job Title/Position: Chart Review/ Compliance Educator
Job Classification: Administrative/Professional Support
How to Apply:
We have over 1200 reasons for you to consider a career with Prevea Health--they're our employees. We're an organization that values teamwork and provides continuous education, training and support so every member of the team contributes to our success. We offer a competitive salary and benefits package in an environment geared to professional and personal growth. No matter what your background or professional interests are, we think you'll like what we have to offer. Together we are the best place to get care and the best place to give care.
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Prevea Health is an Equal Employment Opportunity/Affirmative Action employer.