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Form of work
SalaryResponsible for conducting medical compliance audits identified through internal reviews, risk assessments, the OIG work plan and CMS external audit proposed and approved topics.
Essential Duties and Responsibilities
- Handles RAC, TPE, SMRC
- Appeals any findings from CMS audits and audits done by other payors
- Conducts internal audits as assigned by supervisor
- Educates respective departments about internal and external audit findings and assist with creating a process to improve the issue(s)
Education: Associates-Health Information Management, Healthcare Administration, or other related healthcare field-Required
Certifications: Certified Coding Specialist (CCS)-Required. Must meet exam eligibility requirements and pass within1 year of employment.
Minimum Years of Experience Required
- 1 year experience-Medical record review
- 1 year experience-CMS audits (RAC, TPE, SMRC, etc.)-Preferred
