Audit Services Coordinator

Overview

Position Summary

The primary responsibility for the Audit Services Coordinator is to organize and manage incoming audits and medical records requests for Embark Behavioral Health programs. The basic job responsibilities will be receiving and fulfilling insurance pre and post payment audits, speaking with stakeholders regarding the audit process, submitting medical records as requested, and other duties as assigned. The Audit Services Coordinator is responsible for appropriately and accurately verifying and processing requests for records to be pulled for patient care, quality review, and audits in a timely manner.  First and foremost, this task involves establishing the legitimacy of the request by verifying that the requester has a right of access to the information. Both state and federal regulations, such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA), govern the release of patient information to third parties. The Audit Services Coordinator is responsible for analyzing medical records and audit requests to determine what medical information is being requested and what we are authorized to provide.  Once legitimacy is established, the Audit Services Coordinator gathers the records and documentation requested, organizes the records and documents a cover sheet to demonstrate medical necessity.  The goal is to respond to medical records and audit request within the defined timeframe and to improve the organization by identifying issues that may inhibit the passing of audits.

The team member who joins the Audit Services team must be professional, a self-starter who is able to work in a fast-pace and high-stress environment, and an individual who is self-motivate with the ability to multitask well.

Responsibilities

Primary Responsibilities

• Ability to maintain patient confidentiality at all times
• Ensure validity and integrity of all patient insurance records
• Responsible for coordinating the release of medical information to insurance companies and any other requesting entity
• Appropriately and accurately pulls records as requested by insurance companies and various entities
• Ensure all requests for records are worked on a first in first out basis, unless otherwise requested by the Utilization Review Director
• Maintain productivity standards to effectively handle multiple, concurrent priorities and consistently meet deadlines
• Effectively organize and manage the business day to ensure all assigned medical records requests remain compliant
• Performs quality checks on all work to ensure accuracy of the response and confidentiality
• Provide feedback on deficiencies identified on any audit by reporting findings to the UR Director and related programs. Documentation needs will be addressed to ensure compliance with payors.
• Maintain a good working relationship within the RCM department and with program personnel
• Adhere to Embark BH and RCM requirements, policies, and standards
• Provide excellent customer service by being attentive and responsive to requests
• Other duties as assigned and appropriate

Qualifications

Minimum Qualifications

• High School diploma or equivalent is required, Associate’s degree preferred
• Previous experience in documentation review through audit services or front-end compliance
• Customer Service experience required with residential treatment experience preferred
• Experience with insurance billing and previous audit services experience is preferred
• HIPAA Certification required upon employment
• Ability to maintain confidentiality in compliance with HIPPA Guidelines
• Familiarity with medical terminology, diagnostic terms, and treatment modalities.
• Working knowledge of Windows-based applications, including Outlook, Word and Excel
• Strong and professional communication skills
• Patience and ability to manage stress and maintain confidentiality
• Ability to apply state and federal laws, regulations, and policies governing utilization review.
• Strong written and verbal communication skills
• Exceptional organizational skills and attention to detail
• Self-starter, self-sufficient, self-confident leading to an ability to create a system for medical records and communication with Embark families in multiple programs

Benefits

• Professional growth opportunities driven by cutting-edge strategies and training, guided by exceptional leaders
• Comprehensive benefits, including health, vision, and dental insurance with substantial company contributions, matched 401k plans, life insurance, long-term disability coverage, ample paid time off, company holidays, and paid maternity leave
• PTO accrual schedule
• Join a team of nationally recognized industry leaders who provide you with a framework of training, support, and long-term advancement opportunities.
• A strong culture that embraces the core values of empathy, trusting relationships, service, growth, and results

Embark is an Equal Employment Opportunity Employer. Embark is committed to enriching the therapeutic and healing experience it offers through the diversity of its employees and community. Embark seeks to recruit and support a broadly diverse staff who will contribute to the organization's excellence, diversity of viewpoints and experiences and relevance in a global society.