Job Details

JOB SUMMARY: The Audit Specialist will be responsible for processing external audits, including specialized or focused audits and projects. The individual will also be responsible for tracking and reporting of internal audit schedules and results including analyzing and reporting data for both quality measures and payment. The Audit Specialist will work directly with the Medical Auditor and Management team to ensure audits are conducted in accordance with Federal and State regulatory guidelines.

DUTIES AND RESPONSIBILITIES:

1. Performs reviews of medical records, summarizes the findings and accurately enters information into databases as specified.
2. Solves problems with regard to unique record or process issues.
3. Tracks and validates data accuracy and timeliness in accordance with established guidelines.
4. Compiles data into reports to analyze trends and patterns to assist in the identification of improvement activities and reports information to the appropriate departments, committees or individuals in relation to established goals.
5. Works with various departments to assist them in being compliant with payment guidelines and  quality measures
6. Helps train clinicians and other staff on protocols.
7. Participates in presentations to educate staff on outcomes and new or changing protocols and collaborates with the clinical team to use outcome data in education.
8. Actively participates in problem identification and resolution and coordinates resolution between the appropriate parties.
9. Accurately interprets and follows frequently changing data definitions and guidelines.
10. Takes ownership of projects, researches data and follows through with detailed action plans to completion.
11. Maintains a good working relationship within the department and with other departments.
12. Demonstrates an ability to be flexible, organized and function under stressful situations.
13. Provides accurate and timely written and verbal communication of information in a manner that is understood by all.
14. Able to listen, understand, problem-solve, and carry-out duties to ensure the optimal outcome.
15. Adheres to dress code; appearance is neat and clean.
16. Completes annual education requirements.
17. Maintains patient confidentiality at all times.
18. Reports to work, meetings and professional obligations on time.
19. Represents the organization in a positive and professional manner.
20. Understands current issues, practices and trends in healthcare
21. Performs other related duties as required and assigned.

QUALIFICATIONS:    Education/Certification: High School Diploma or GED. CPC

Certification is not required, but preferred. Knowledge of medical terminology, regulatory guidelines and revenue cycle.

Experience: 1-3 years of medical experience.

Equipment/Technology: Proficient computer skills, to include the navigation of several electronic databases. Knowledge of Microsoft Excel and Word. 

Language/Communication: Excellent written and verbal communication skills, demonstrated ability to work independently, show initiative, and meet established goals and deadlines.

Mathematical Skills: Basic understanding of math and concepts to calculate percent of accuracy and deficiencies.

Mental Capabilities: Can concentrate for long periods of time in order to complete assigned tasks with a better than average attention span in order to listen, read and remember verbal and written instructions.

Interpersonal: Contributes toward effective, positive working relationships with internal and external colleagues. Demonstrates cooperation, flexibility, reliability, and dependability in all daily work activities, and a willingness to collaborate with others for the good of the organization

Performance: Can work well under pressure and meet multiple and competing deadlines. Hold oneself to high standards and professionalism