What are the responsibilities and job description for the Audit Clinical Data Coordinator position at Lehigh Valley Hospital?
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Summary
Works with all clinical audit teams, compliance department, and specific departments to maintain an organized and timely logging, gathering of documentation, tracking, and follow–up of all audits including recovery audit contractor and any third–party request activities. Follow–up and support data, manages the data and organization, and administrative needs to all clinical audit teams to help with reporting of data and identifying trends.
Job Duties
- Analyze data of requested claims and applies critical analytic thinking to identify pre and post–pay audit trends and claim denial trends by facility location, payers, and services lines to prepare reports to reflect RAC audits, insurance, and third–party activities and claim denials.
- Logs all audit and claim denial requests, review findings, and determinations into the audit and tracking data base and evaluate logging and tracking processes and log all claim denials.
- Identify workflow road blocks and makes recommendations to management and software vendor.
- Develops and maintains a productive client, staff, and management relationships through individual contacts, events, and group meetings.
- Communicate the results of audit activities via written report and oral presentation to management.
- Completes follow–up and closing of audits.
- Creates educational materials on use of audit tracking software and provides ongoing training to staff.
- Works, reviews, and files all mail coming in via fax / scanning / e–mail and assign to most appropriate work queues for the Audit Compliance and Data Coordinator team to work.
- Coordinators sending of appeals via RightFax while creating a database of all appeals sent.
- Assist clinical audit and follow–up teams with write–offs and assigned to management work queue.
- Attend monthly insurance / payer vendor meetings to ensure up to date information on policy updates / billing updates / etc. Maintains open communication with insurance / vendor representatives.
Minimum Qualifications
Preferred Qualifications
Physical Demands
Lift and carry 7 lbs., continuous sitting >
67%, frequent keyboard use / repetitive motion, frequent fine motor activity / wrist position deviation.
Job Description Disclaimer : This position description provides the major duties / responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.
Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and / or social activities.
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