The Chart Auditor will be responsible for performing clinical reviews to determine the accuracy of ICD-10 codes listed on forms from payors, performing interactive outreach for the Transition of Care program, pending outstanding patient orders, validating ED high utilization patient attribution, and reviewing gap in care reports to address outstanding patient health risks. This job involves accessing proprietary systems to audit medical records, accurately documenting findings, and providing forms to the clinic providers.
Essential Job Functions & Accountabilities: Reviews and interprets medical records and compares against forms for accuracy of presumed diagnoses. Documents decisions and rationale to justify review findings. Pend orders to address outstanding patient care gaps.
Performs interactive outreach for patients discharged from Inpatient stays. Assists management with training any new Chart Auditor. Maintains current knowledge of clinical criteria guidelines to maintain a clinical license.
Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations. Actively cross-trains to perform reviews of multiple payor types and requirements and understand the documentation needs. Recommends, tests, and implements process improvements, new audit concepts, and technology improvements that will enhance production, quality, and client satisfaction.
Reviews payor gap in care reports to validate patient medication adherence compliance. Validates and facilitates care management for high ED utilizing patients.
is not an all-inclusive list of duties and may be subject to change with or without notice. Staff are expected to perform other duties as assigned.