Senior Medical Documentation Auditor

About the role

The Senior Medical Documentation Auditor works under the direction of the Associate Director of Compliance Programs to support the UNLV Health Compliance Program. The auditor will design and execute audits of medical records, conduct educational training sessions with clinicians based on audit results, and research and respond to inquiries. Identifies organizational risks and coding trends by performing audits and reviewing analytical data. Educates physicians and clinical staff to improve medical documentation to align with medical record documentation requirements. Develops and executes audits applying technical audit and computer software skills to prepare accurate and detailed audit reports mitigating liability to the organization.

Responsibilities

• Plan, develop and execute reviews (audit, assessments, investigations) to evaluate medical records for compliance with documentation, coverage, coding and billing guidelines.
• Develop and conduct education programs for physicians (attending, fellows, residents) and clinical staff (PA, NP/APRN, RN, LPV/LVN, therapists, medical assistants) on documentation, coverage, coding and billing guidelines.
• Prepare detailed audit reports and documentation to support findings of deficiencies and recommendations for improvements or corrections.
• Ensure correct application of ICD-10, CPT, and HCPCS codes for diagnoses, treatments, procedures, and services.
• Implement corrective actions and educate physicians and clinical staff to improve medical documentation to be in line with medical record documentation requirements.
• Research and respond to inquiries submitted by providers, coders and administrative staff regarding medical records documentation.
• Act as the compliance liaison with faculty members, developing relationships and functioning as a resource to all providers and their staff relating to audits and results.
• Serve as an institutional subject matter expert and authoritative resource on medical record documentation requirements.
• Maintain up-to-date information on all standards set by Medicare, Medicaid, and other entities relating to medical record documentation requirements.
• Analyze audit data to track trends, identify recurring issues, and provide feedback to improve overall coding accuracy.
• Assist with internal and external audits, responding to any documentation/coding-related queries.
• Support the development and implementation of a compliance program that includes regular audits, feedback mechanisms, and policy updates.
• Assist with onboarding new physicians and provide ongoing education to ensure adherence to coding standards.
• Complete any duties and special assignments as requested.

Requirements

Candidates must be legally authorized to work in the United States. UNLV Health does not provide employment sponsorships or sponsorship transfers for any positions.

Qualifications

• Minimum of five (5) years of experience in healthcare compliance, medical coding, and/or related field required; or minimum of eight (8) years of experience in lieu of a Bachelor’s degree.
• High School Diploma or GED equivalency required.
• Bachelor's Degree in Business, Healthcare, and/or related field preferred.
• Certified Professional Medical Auditor certification (CPMA) required.
• Relevant industry certifications (must have at least one): Certified Professional Coder (e.g., AAPC, AHI