Join our Talent Network
Skip to main content

Clinical Audit Consultant

Charlotte, NC, United States
Job ID: 30132
Status: Full Time
Shift: Day
Shift Details: Regular
Department Name: 51011028344654-Corporate Privacy
Location: Atrium Corporate Operations

Overview

JOB SUMMARY:

Serves as a clinical consultant for activities related to clinical documentation, medical coding and health insurance coverage decisions around medical necessity. Evaluates clinical documentation in regards to government and other payors rules and regulations and provides guidance and education regarding appropriate documentation and application. Responsible for researching and monitoring rules and regulations and internal process around clinical documentation that are used to support billing. Provides assistance to the Enterprise Compliance Office in monitoring clinical quality issues.

 

EDUCATION/EXPERIENCE:

MD or Bachelor's degree in Nursing or related field with five years of healthcare experience with a focus on clinical documentation and compliance activities.

 

LICENSURE, CERTIFICATION, and/or REGISTRATION:

Clinical certification such as MD, PA, NP or RN.

 

ESSENTIAL FUNCTIONS:

1. Assists with the development and completion of the Enterprise’s Compliance Plan and the annual compliance work plan. Performs continual assessments of the risks facing the Enterprise with a focus on clinical documentation (particularly as it relates to billing), clinical quality issues, and medical necessity.

2. Serves as a consultant to the Director and Managers of Physician Compliance as it relates to physician/provider documentation and coding. Provides education and training as needed to Atrium Health providers and staff related to documentation, coding and medical necessity coverage rules.

3. Maintains an advanced knowledge of current clinical documentation and medical necessity regulatory activity, reimbursement and coding guidelines. Analyzes Enterprise activity for potential concerns related to compliance with rules and regulations. Researches issues raised by faculty, providers, and staff and coordinates with Compliance Office leaders, the Office of General Counsel, and other Enterprise departments to answer the questions related to identified compliance concerns.

4. Initiates and reviews Enterprise policies related to clinical documentation/quality/medical necessity for compliance with laws and regulations. Develops and reviews Enterprise and departmental polices as part of the Enterprise Compliance Office’s oversight activities to ensure compliance with rules and regulations regarding clinical documentation/quality/medical necessity. Participates in the development of new or recommends changes to current Enterprise and departmental policies addressed at complying with changes related to compliance.

5. Addresses Enterprise clinical documentation/quality/medical necessity related compliance issues that are identified through scheduled audits, regulatory changes, or internal/external parties. Researches the relevant laws/regulations and assess the identified concern through the collection and interpretation of data. Develops, in coordination with other leaders in the Enterprise Compliance Office, an action plan to address the compliance issue and monitors the resolution of the issue. Ensures that the issue and its resolution are properly communicated to appropriate parties.

6. Communicates findings and review results effectively and encourages faculty, providers and staff to report compliance issues to the Enterprise Compliance Office. Assists in communicating issues to leadership and governance Compliance Committees and associated sub-councils.

7. Completes other projects as assigned.

8. Adheres and exemplifies the Enterprise's standards of conduct and promotes a cooperative work environment by utilizing communications skills, interpersonal relationships, and team building.

 

SKILLS/QUALIFICATIONS:

High moral and ethical standards. Strong interpersonal skills and ability to interface at all levels. Excellent oral, written, and listening communication skills. Ability to work with management in stressful situations. Strong analytical ability Familiarity with broad guidelines over the healthcare industry. Extensive working knowledge of Medicare and Medicaid regulations. Ability to act as a leader, team player and facilitate large groups.

 

WORK ENVIRONMENT:

Clean, comfortable, traditional office space. Frequent employee and professional contact.

Similar Jobs

Clinical Audit Consultant
Charlotte, NC, United States