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Become A Medical Auditor

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Working As A Medical Auditor

  • Getting Information
  • Processing Information
  • Documenting/Recording Information
  • Interacting With Computers
  • Organizing, Planning, and Prioritizing Work
  • Mostly Sitting

  • Repetitive

  • $63,565

    Average Salary

What Does A Medical Auditor Do At CHS

* Conduct medical record documentation and coding/billing audits, assessing the accuracy of ICD
* CM/PCS, CPT, HCPCS codes, modifier assignments, etc.; determining compliance with appropriate policies, procedures, and Federal and state regulations.
* Identify procedural and system weaknesses and offer guidance to Management for process improvements.
* Conduct audits according to the Compliance work plan and as requested.
* Plan and organize work assignments to complete projects in an efficient manner.
* Produce high-quality work that is competently and efficiently performed in accordance with department standards.
* Prepare comprehensive reports, making recommendations to correct deficiencies and practice or process improvements.
* Monitor to identify patterns, trends and variances related to auditing and monitoring projects.
* Conduct follow-up audits if indicated to appraise the adequacy of corrective actions and determine whether deficiencies are corrected; prepare the appropriate reports for management.
* Provide coding and documentation guidance to medical and coding staff and management as needed.
* Participate in the design and implementation of a risk based annual compliance audit work plan incorporating governmental and other agency regulations, internal Compliance Program requirements, and operational policies and procedures.
* Prepare and present quarterly reports of incumbent’s projects to the Compliance Leadership.
* Keep abreast of related coding guidelines and reporting requirements.
* Maintain professional skills and knowledge through attendance at relevant conferences, seminars and other educational programs; participate in professional organizations; and review current literature.
* Other Responsibilities:
* Adheres to the Organizational policies and procedures
* Maintains strict confidentiality of client, company and personnel information
* Demonstrates a strong commitment to the mission and values of the organization
* Adheres to company attendance standards
* Performs other duties as assigned
* Supervisory Responsibilities: None

What Does A Medical Auditor Do At UPMC

* Attend department meetings and present educational update or discuss unique audit findings and recommendations as requested by the Compliance Manager.
* Complete, review, and submit summaries to Compliance Manager or appropriate department staff.
* Conduct post-audit compliance training sessions for PSD physicians and non-physician practitioners as audit results dictate.
* These training sessions will include, but are not limited to, provision of education specific to the issues found on audit and will be largely based on the documentation, coding and billing rules as set forth by CMS and other relevant Federal and State regulatory agencies.
* Consult with physicians and physician staff, as needed, on documentation issues, and other regulatory issues as they arise.
* Develop and manage relationships with colleagues in a professional, independent manner to create an environment that affects necessary change to systems effecting the documentation, billing or coding services.
* Perform internal retrospective, concurrent or prospective medical chart audits to assure that CPT codes billed are appropriate and supported by documentation in the patient record, and that all coding/documentation combinations are compliant with Federal and State regulations.
* Report status of all assignments and pertinent information to Compliance Manager.
* Responsible for conducting special projects, which may include audits, as necessary.
* Special projects may require spreadsheet development as well as reports that summarize outcome of special projects.
* Responsible for evaluating process and/or operational issues throughout PSD

What Does A Medical Auditor Do At Ascension Health

* Leads or coordinates shift operations of assigned activities, resources, and/or associates.
* Serves as a technical or functional resource and performs similar duties with staff.
* Assigns, monitors and reviews progress of work.
* Monitors and reports compliance with policies and/or procedures.
* Oversees and evaluates orientation and training of assigned associates.
* May provide input in the review and evaluation of staff performance.
* Is responsible for education of all physician and midlevel providers regarding coding compliance standards set forth by Federal or State, accrediting bodies and third party requirements.
* This position will be responsible for carrying out the standards established by the Ascension Health Corporate Responsibilities Program as it relates to professional coding and the Borgess Medical Group Coding and Data Integrity Audit Compliance Program
* This position will be responsible for reviewing the results of periodic coding audits in face-to-face meetings with providers in a timely and effective manner for all employed and contracted providers whose services are billed by Borgess-owned provider practices.
* Ensures that providers have the understanding and tools necessary for appropriate evaluation & management, procedure and diagnosis documentation
* Will ensure accurate reporting of services for appropriate reimbursement and supports corporate compliance
* The education and audit reviews will cover a wide spectrum of specialties performing professional services in many different settings such as inpatient facility, outpatient facility, physician offices and nursing homes
* The above is intended to describe the general content of and requirements for the performance of this job.
* It is not to be construed as an exhaustive statement of duties, responsibilities or requirements

What Does A Medical Auditor Do At Lumeris

* The Auditor will interpret medical information such as diseases, conditions, or symptoms, and diagnostic descriptions and procedures for a given visit in order to accurately assign and sequence the correct ICD
* CM
* Validate provider diagnosis coding for accuracy by reviewing of coding documentation and claims extract compared to actual medical records
* Review and identify trends in coding discrepancies and notify applicable department for potential training and education
* Determine coding issues and discrepancies and make updates as necessary
* Reviews coded patient charts, utilizing the medical charts (both paper and electronic) and previously applied codes and compares both to ensure accuracy, while making written notes of findings and communicating those findings with leadership.
* May be required to notify team members directly and individually via e-mail or telephone of instances where serious deficiencies necessitate focused reviews.
* Discusses with the Coding Manager issues/questions/problems which may arise.
* Maintain acceptable levels of attendance and punctuality as specified in company and departmental policies.
* Meet routine deadlines and work schedules as well as timely and accurate completion of special projects and any other duties as assigned.
* Understand, support, enforce and comply with company policies, procedures and Standards of Business Ethics and Conduct.
* Display a positive attitude as well as professional, polite, considerate and courteous conduct and treatment of others in the course of duties.
* Applies comprehensive knowledge of medical terminology, anatomy & physiology, disease processes, treatment modalities, diagnostic tests, medications, procedures as well as the principles and practices of health services and the organizational structure to ensure proper code selection.
* Provides verbal and written reports of the results of coding audits, to include recommendations for corrective action and improved accuracy.
* Provide coverage for other compliance disciplines and complete other duties as assigned.
* Some travel to other markets may be required

What Does A Medical Auditor Do At Intertek

* Audit client management systems for compliance with established standards, client, and/or industry requirements, government regulations, and other relevant standards, specifically ISO 13485, ISO 9001, Canadian Medical Devices Regulations (CMDR), Medical Device Directive (MDD 93/42/EEC) and other requirements related to the medical device industry sector.
* Assist clients with questions relevant to the audit and/or certification process.
* Act as Lead Auditor or team member.
* Coordinate audit activity with team members.
* Liaison with client regarding audit activity.
* Review client's quality management system documentation.
* Verify and document evidence of compliance and non-compliance.
* Prepare audit report.
* Review audit results with coordinator and other assessment team members.
* Make presentations to clients and/or certification board concerning audit results, when required.
* Assist with corrective action requirements resulting from assessments.
* Participate in audit meetings.
* Review audit reports and provide technical assistance to the medical team.
* Support management in areas of continuous improvement.
* Provide management with updates on status of work, initiatives, and projects, as required.
* Travel will include overnight/multiple days, to various worksites and client locations

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How To Become A Medical Auditor

Health information technicians typically need a postsecondary certificate to enter the occupation, although some may need an associate’s degree. Certification is often required.

Education

Postsecondary certificate and associate’s degree programs in health information technology typically include courses in medical terminology, anatomy and physiology, health data requirements and standards, classification and coding systems, healthcare reimbursement methods, healthcare statistics, and computer systems. Applicants to health information technology programs may increase their chances of admission by taking high school courses in health, computer science, math, and biology.

A high school diploma or equivalent and previous experience in a healthcare setting are enough to qualify for some positions, but most jobs for health information technicians require postsecondary education.

Important Qualities

Analytical skills. Health information technicians must be able to understand and follow medical records and diagnoses, and then decide how best to code them in a patient’s medical records.

Detail oriented. Health information technicians must be accurate when recording and coding patient information.

Integrity. Health information technicians work with patient data that are required, by law, to be kept confidential. They must exercise caution and a strong sense of ethics when working with this information in order to protect patient confidentiality.

Interpersonal skills. Health information technicians need to be able to discuss patient information, discrepancies, and data requirements with other professionals such as physicians and finance personnel.

Technical skills. Health information technicians must be able to use coding and classification software and the electronic health record (EHR) system that their healthcare organization or physician practice has adopted.

Licenses, Certifications, and Registrations

Most employers prefer to hire health information technicians who have certification, or they may expect applicants to earn certification shortly after being hired. A health information technician can earn certification from several organizations. Certifications include the Registered Health Information Technician (RHIT) and the Certified Tumor Registrar (CTR), among others.

Some organizations base certification on passing an exam. Others require graduation from an accredited program. Many coding certifications also require coding experience in a work setting. Once certified, technicians typically must renew their certification regularly and take continuing education courses.

A few states and facilities require cancer registrars to be licensed. Licensure requires the completion of a formal education program and the Certified Tumor Registrar (CTR) certification.

Advancement

Health information technicians may advance to other health information positions by receiving additional education and certifications. Technicians may be able to advance to a position as a medical or health services manager after completing a bachelor’s or master’s degree program and taking the required certification courses. Requirements vary by facility.

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Medical Auditor jobs

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Top Skills for A Medical Auditor

MedicalRecordReviewAuditFindingsEnsureComplianceProvidersGuidelinesCpt-4MedicalGroupHealthcareHcpcsInsuranceCompaniesMedicaidPolicyProcedureCodesMedicalFacilitiesElectronicMedicalRecordsIcd-9-CmHipaaAuditResultsMedicalNecessityMedicalCharts

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Top Medical Auditor Skills

  1. Medical Record Review
  2. Audit Findings
  3. Ensure Compliance
You can check out examples of real life uses of top skills on resumes here:
  • Provided concurrent medical record review at Duke University Medical Center.
  • Present audit findings to physicians improving documentation errors and discrepancies.
  • Prepare reports from the interviews realized on patients to ensure compliance to health laws and regulations.
  • Verified that the documentation was not altered and that there was no waste of the medications that the HIT providers billed.
  • Trained providers on targeted areas of improvement to bring their programs in compliance with federal guidelines.

Top Medical Auditor Employers

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