Job Description

The Auditing & Monitoring Specialist is responsible for reviewing medical records in their entirety to ensure accurate and compliant EM, CPT and ICD-10-CM coding, per federal regulations and guidelines set by CMS/HIPAA and communicating errors promptly to the physician, or other qualified health care provider. The Auditing & Monitoring Specialist assists in providing educational training and understanding to physicians, mid-levels, clinical personnel, and other departments, as necessary.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

The following duties and responsibilities generally reflect the expectations of this position but are not intended to be all inclusive, other duties may be assigned:

-Assist with new on-boarding of providers coding and documentation training
-Educate new providers proper coding and documentation requirements and perform pre-bill & post bill audits, documentation review, spot auditing, and coding accuracy checks
-Perform provider documentation audits and reviews of medical records to ensure compliance with coding and documentation standards and comply with Medicare/Medicaid guidelines
-Provide education/training to providers, clinical team members, coding team members and other individuals as necessary
-Conduct periodic meetings with providers to include chart reviews, coding reviews for over/under coding patterns, coding patterns in general and code specific revenue enhancement opportunities
-Work closely with the Auditing & Monitoring Team Lead to identify potential risk areas and/or providers who require additional education
-Perform other duties as assigned
-Follows the direction of the Quality Assurance Manager with regards to all assigned duties

EDUCATION AND/OR CERTIFICATIONS
High School Diploma (or GED equivalent) is required
Associate degree in Health Information Technology is preferred
Certified Professional Coder is required

SKILLS AND QUALIFICATIONS
Previous or current long-term care experience required
Knowledge of ICD-10 Coding Procedures and HIPAA regulations
Experience with an Electronic Medical Record (EMR) and/or practice management system
Familiarity with medical terminology required 
Knowledge of HIPAA privacy laws and commitment to privacy, security, and confidentiality of all medical chart documentation 
Competent knowledge of Microsoft office; strong Excel skills required 
Ability to work under pressure of tight deadlines and complete task accurately  
Ability to effectively handle multiple priorities 
Strong level of detail and accuracy
Ability to utilize resources provided to research topics/insurance guidelines to ensure accurate ICD and ICPT coding.

LANGUAGE SKILLS:
Ability to communicate clearly and concisely in verbal and written form.
Customer service attitude.
Must be able to frequently communicate with facilities and patients and/or with others about patient or provider requirements, complaints, and common inquiries.
Strong communication skills via verbal and written and will be able to speak with providers and clinical team members confidently.

About Eventus WholeHealth:
Eventus WholeHealth was founded in 2014 to provide physician-led healthcare services for residents and patients of skilled nursing and assisted living facilities. With our highly-trained team of physicians, psychiatrists, nurse practitioners, physician assistants, psychotherapists, podiatrists, optometrists, audiologists, and support staff, our comprehensive, evidence-based model provides collaborative interdisciplinary care with the seamless and vital integration of a wide range of specialties. Our differentiated approach not only empowers the facilities to reach their own goals and objectives but also ensures better patient outcomes. For more information, please visit www.eventuswholehealth.com.