HIM Audit Clerk

DEPARTMENT: HEALTH INFORMATION MANAGEMENT F ACILITY: Medical Office Building WORK TYPE: Full Time S HIFT: Daytime

The HIM Audit Clerk is responsible for supporting internal and external audit activities related to medical record documentation, coding, and billing compliance. This role plays a key part in responding to and managing audits such as Targeted Probe and Educate (TPE), Comprehensive Error Rate Testing (CERT/CDR), Clinical Laboratory Documentation Reviews (CLDR), and other payer or regulatory audits. The position requires a strong understanding of coding, billing, and medical record documentation standards to ensure timely, accurate, and compliant audit responses.

* Manage and coordinate audit requests including TPE, CDR/CERT, CLDR, RAC, MAC, commercial payer, and internal audits * Review medical records to ensure documentation supports billed services, diagnoses, and procedures * Perform pre-submission and post-submission audits for coding and billing accuracy * Validate physician documentation for completeness, signatures, and compliance with regulatory requirements * Collaborate with coding, billing, CDI, providers, and clinical staff to resolve audit findings * Prepare and submit audit responses within required timeframes * Track audit requests, submissions, outcomes, and trends using audit logs or tracking tools * Identify patterns or recurring issues and report findings to HIM leadership * Assist with education and feedback for providers and staff based on audit results * Ensure audit documentation is properly indexed and maintained in the electronic health record * Maintain knowledge of CMS, payer guidelines, and regulatory requirements related to audits * Support process improvement initiatives related to documentation, coding accuracy, and compliance * Maintain confidentiality and compliance with HIPAA and organizational policies * Keeps abreast of pertinent federal, and state regulations and laws and Tift Regional Health System, Inc.

(“TRHS”) policies as they presently exist and as they change or are modified. * Understands and adheres to: TRHS’ compliance standards as they appear in TRHS’s Corporate Compliance Policy, Code of Conduct and Conflict of Interest Policy; and HIPAA and TRHS policies regarding privacy and security of protected health information. * Demonstrates the ability to perform tasks that meet the age-specific requirements of the persons, patients, vendors, and staff that the employee is charged to interact with as required by the position. * Offers suggestions on ways to improve operations of department and reduce costs. * Attends all mandatory education programs. * Improves self-knowledge through voluntarily attending continuing education/certification classes. * Maintains required competency levels as identified in written exams, skills checklists, skills labs, annual safety and health requirements as well as service excellence education hours requirements. * Cross-trains in order to better assist co-workers and to provide maximum efficiency in the department. * Volunteers/participates on hospital committees, functions, and department projects. * Manages resources effectively. * Reports equipment in need of repair in order to extend life of equipment and removes malfunctioning equipment out of service with timely reporting to the appropriate personnel. * Makes good use of time so as to not create needless overtime.

* Associate's Degree CREDENTIALS: * REGISTERED HEALTH INFORMATION TECHNOLOGIST * REGISTERED HEALTH INFORMATION ADMINISTRATOR * Certified Coding Specialist * Certified Professional Coder * Certified Professional Medical Auditor OTHER INFORMATION: Associate degree in health information management or related field required. Must maintain at least one of the following credentials: RHIT, RHIA, CCS, CPC, CPMA or equivalent Southwell/Tift Regional Health System, Inc. is an Equal Opportunity Employer.