New Job Government Audit Coord In North Carolina
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| Government Audit Coord |
Government Audit Coord
Company : Cone Health
Salary : Details not provided
Location : North Carolina
Full Description
Overview:
The Government Audit Coordinator will oversee the Government Audit implementation and response team. Develop workflows, policies and procedures and the communication plan to prepare for audit requests, denials and appeals in accordance with our compliance plan. Evaluates and reports risk and develops workflow redesign if necessary.
Responsibilities:
Audit Request: Manages all requests received from government audit Payor/contractor. Ensure chart documentation has been reviewed before mailing to include cover letter pointing out medical necessity and admission screening documentation. Maintains copies of all documentation sent. Ensures documentation is mailed within the time frame. No exceptions.
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Appeals: Administers the appeal and denial process. Follows appeal and denial process through the entire 5 Levels of appeal until a resolution is made .Documents the outcome of each level of appeal. Completes workque in EPIC/electronic medical record to ensure accounts continue to process appropriately
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Documentation: Ensures required information is documented into the tracking system upon receipt of denial or request from Payor/Contractor. Identifying reason for denial or request and updates system until resolution is complete. Maintaining 100% accuracy. Collect, organize and interpret data for identification and prioritization of areas of risk. Maintaining and submitting reports timely. Performs concurrent documentation reviews of selected records to clarify conditions/diagnoses and procedures. Recognizing the need for additional documentation or clarification and secures the documentation from the appropriate person. Displays extensive knowledge of documentation standards required by licensing/regulatory agencies and documentation standards/guidelines relating to coding/billing.
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Reviews/Policy: Develops changes to organizational practice, policies and procedures as needed in response to audit issues. Coordinates reviews for audit testing to ensure established regulations and policies are met. Monitors and identify potential issues. Complies reports as a result of reviews. Remains current through education and participation with various organizations.
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Reporting: Reports to Compliance Officer and/or Administration information such as the likelihood of denial; dollar amount of account; any identified documentation issues and reports progress. Works with Revenue Cycle, HIM, Compliance, CFO and Legal Counsel on guidelines to follow audit responses and to ensure smooth workflow.
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Appeals: Administers the appeal and denial process. Follows appeal and denial process through the entire 5 Levels of appeal until a resolution is made .Documents the outcome of each level of appeal. Completes workque in EPIC/electronic medical record to ensure accounts continue to process appropriately
-
Documentation: Ensures required information is documented into the tracking system upon receipt of denial or request from Payor/Contractor. Identifying reason for denial or request and updates system until resolution is complete. Maintaining 100% accuracy. Collect, organize and interpret data for identification and prioritization of areas of risk. Maintaining and submitting reports timely. Performs concurrent documentation reviews of selected records to clarify conditions/diagnoses and procedures. Recognizing the need for additional documentation or clarification and secures the documentation from the appropriate person. Displays extensive knowledge of documentation standards required by licensing/regulatory agencies and documentation standards/guidelines relating to coding/billing.
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Reviews/Policy: Develops changes to organizational practice, policies and procedures as needed in response to audit issues. Coordinates reviews for audit testing to ensure established regulations and policies are met. Monitors and identify potential issues. Complies reports as a result of reviews. Remains current through education and participation with various organizations.
-
Reporting: Reports to Compliance Officer and/or Administration information such as the likelihood of denial; dollar amount of account; any identified documentation issues and reports progress. Works with Revenue Cycle, HIM, Compliance, CFO and Legal Counsel on guidelines to follow audit responses and to ensure smooth workflow.
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EDUCATION:
Required: Associates in Nursing
Preferred: Bachelors in Nursing
Graduate of a School of Nursing. BSN required or with approval of the hiring manager, experienced RN's with an AD or Diploma with an active plan to obtain their BSN within four years from date of hire may be considered.
Preferred: Bachelors in Nursing
Graduate of a School of Nursing. BSN required or with approval of the hiring manager, experienced RN's with an AD or Diploma with an active plan to obtain their BSN within four years from date of hire may be considered.
EXPERIENCE:
Preferred: 5-7 years experience with chart reviews
LICENSURE/CERTIFICATION/REGISTRY/LISTING:
REQUIRED
RN | Registered Nurse licensed in North Carolina or a Compact state.
PREFERRED
RN | Registered Nurse licensed in North Carolina or a Compact state.
PREFERRED