What are the responsibilities and job description for the HIM Appeals Auditor position at Regional West Medical Center?
About the Role:
As a HIM Appeals Auditor, you will be responsible for managing and coordinating all aspects of Recovery Audit Contractor (RAC) audits and Demonstration High-Risk Diagnosis Related Group (DRG) reviews. This crucial roles involves handing incoming audit request, ensuring the timely release of medical records, tracking audit information and providing necessary education to healthcare providers to improve audit outcome. The Appeals Auditor will collaborate closely with the Sr. Director of Revenue Cycle, Case Management, CDI, and billing office staff. Reporting on a regular schedule to the executive team on all audit progress and findings.
Minimum Qualifications:
- Familiarity with electronic health record (EHR) systems
- 2 years of experience in healthcare auditing, compliance, or related roles
- Excellent communication and interpersonal skills
- Ability to work independently and as part of a team
Preferred Qualifications:
- Associate degree or bachelor's degree in Health Information Management
- Registered Health Information Administrator (RHIA), Clinical Coding Specialist (CCS), or Registered Health Information Technologist (RHIT) certifications
- Strong attention to detail and analytical skills
Responsibilities:
- Receive and process all incoming RAC and DRG audit requests promptly and accurately
- Oversee the secure and timely release of medical records to payors, maintaining strict confidentiality and privacy standards
- Develop and maintain a comprehensive tracking system for all ongoing RAC and DRG audits
- Collaborate with healthcare professionals to provide education on RAC and DRG audit processes and documentation requirements
- Analyze audit trends and identify areas where process improvement are needed
