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Role Description

This position assumes the lead role in planning, organizing and conducting clinical compliance and operational audits of various functions, departments and/or activities of UnityPoint Health (UPH) and its affiliates.

• Identify and evaluate clinical areas of vulnerability and regulatory risk
• Collaborate with UPH Management to strengthen the internal control environment
• Improve clinical documentation and reimbursement

Hours: Monday-Friday, standard business hours

Location: Remote - applicants preferably reside within the UPH footprint of Iowa, Illinois, or Wisconsin

Qualifications

• BSN - Bachelor's degree in nursing
• Current RN license required
• Minimum of five years audit and/or clinical chart review experience with a healthcare organization or insurance company
• Experience related to coding, billing, proper documentation, medical necessity, and/or reimbursement
• Working knowledge and experience with medical terminology, patient care services, medical record chart documentation (inpatient and outpatient), ICD-9 and ICD-10 diagnostic and CPT procedural coding
• Experience with medical coding and/or medical records documentation audits is preferred
• Familiarity with the Epic electronic medical records platform preferred

Requirements

• Demonstrates knowledge of basic audit skills and adheres to Internal Audit Standards and UPH Internal Audit policies and methodologies
• Utilize system software to efficiently research, document and test areas of risk
• Validate diagnosis and procedure codes assigned are adequately supported by documentation in the medical record
• Regularly researches and utilizes outside resources to maintain and update knowledge of trending risks and best practices within the healthcare industry
• Communicates audit test results and collaborates with UPH Management to identify effective action plans to address audit findings
• Follows up with UPH Management to ensure action plans are implemented timely
• Researches and develops appropriate audit programs and testing procedures that address compliance with clinical documentation requirements, coding, billing and other regulatory issues
• Assesses clinical documentation, coding and billing practices for compliance with regulations of federal and state agencies and third party payers
• Develops sound conclusions supported by audit evidence; identifies opportunities to improve compliance and operating efficiency
• Works with management to improve UPH staff education, compliance and controls related to clinical documentation, coding, billing and other regulatory issues
• Assists Internal Audit Management with research and/or risk interviews during the annual risk assessment
• Provides input on the preparation of the annual Audit Plan
• Participates in establishing and preparing departmental goals, standards, procedures and instructions which contribute to the efficiency and effectiveness of the department
• Works collaboratively with other staff members to ensure optimal team functionality
• Provides status reports on a regular basis for assigned projects
• Maintains a high level of independence and objectivity
• Performs special audit assignments and investigations as required

Benefits

• Paid time off, parental leave, 401K matching and an employee recognition program
• Dental and health insurance, paid holidays, short and long-term disability and more
• Pet insurance for your four-legged family members
• Early access to earned wages with Daily Pay
• Tuition reimbursement to help further your career
• Adoption assistance to help you grow your family