Senior Medical Documentation Auditor - Hybrid

Responsibilities

• Plan, develop and execute reviews (i.e., audit, assessments, and investigations) to evaluate the medical records for compliance with established documentation, coverage, coding and billing guidelines.
• Develop and conduct education programs for physicians (i.e., attending, fellows, and residents) and clinical staff (PA, NP/APRN, RN, LPV/LVN, therapists, and 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 the correct application of ICD-10, CPT, and HCPCS codes for diagnoses, treatments, procedures, and services provided.
• Implement corrective actions and educate physicians and clinical staff to improve their 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.
• Serve 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.
• 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.
• Completes any duties and special assignments as requested.

Requirements

• 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 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, AHIMA), Certified in Healthcare Compliance (CHC) certification or equivalent.

Qualifications

• Advanced knowledge and experience conducting Medical Record audits and ability to interpret and apply Federal and State regulations, coding and billing requirements.
• Advanced knowledge and experience in communicating audit results to medical and administrative professionals.
• Advanced knowledge on coding for Multi-Specialty Clinics.
• Advanced experience in training medical and administrative professionals on coding requirements as outlined by CMS.
• Advanced knowledge of HIPAA and other information privacy and security requirements.
• Advanced knowledge of medical diagnostic and procedural terminology.
• Advanced knowledge of outpatient coding practices at both the clinical and inpatient settings.
• Advanced knowledge of compliance and regulatory requirements including outpatient CMS regulations.
• Demonstrated ability to constructively and sensitively provide feedback to providers and medical center leadership regarding federal and state coding, medical documentation and compliance guidelines, audit results and risk areas.
• Demonstrated proficiency in Microsoft Office (Word, Outlook, Excel, and Power Point).
• Excellent verbal and written communication skills.
• Must be able to work independently with minimal supervision.
• Must be able to work within a team environment.
• Must be able to multitask and prioritize work in a fast-paced environment.
• Must be able to maintain confidentiality.
• Must be able to pay close attention to details.
• Must be able to travel between local facilities and offices as needed for meetings and training.

Benefits

• Working Monday through Friday, 8AM to 5PM.
• 12 Full-Day and 2 Half-Day Paid Holidays per year, starting with your first day of employment.
• 22 PTO days per year.
• 3% 401K Contribution, even if you do not contribute (after 90 days).
• Medical, Dental, and Vision benefits that start the first of the month following your start date.
• Major Advantages of Working for UNLV Health: Advantages of working for UNLV Health include a competitive compensation package, a supportive and collaborative work environment, and opportunities for professional growth and development.

Pay

• Competitive salary commensurate with experience.

Schedule

• Hybrid position.