Regulatory Audit Specialist
DCH Health System - Tuscaloosa, AL

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Performance Planning Supports the HIM Regulatory Audit Supervisor in the processing of all requests for medical records related to the CMS(Medicare) audits for all DCH System hospitals. Assures records are complete and prepared for timely submission, enters data into the Audit Monitoring System and tracks the records from the time of submission, follow-up, appeal(if applicable) and closing. Provides reports to identify trends in the audit process. Must develop the trust and confidence of all applicable departments in tracking and processing recovery audit contractor requests. Must demonstrate that the objectives are being achieved by timely processing and tracking requests through each phase.

Key Responsibilities/Essential Functions
  • Reviews and assesses correspondence received from the Contractors and determine, according to policies, the appropriate individual(s) to review and respond to the request. Assures that documentation to support all charges submitted on the Uniform Bill is available for submission to the Audit Contractor.
  • Must review and assess the quality of the medical records to provide as complete a medical record as possible before releasing to the Audit Contractor
  • Notifies the appropriate management team of records requested and ensures review of the record prior to copying, when appropriate.
  • Coordinates with other departments any additional information to be submitted with the copies of the medical record.
  • Enters data into the Audit Monitoring System upon initial receipt and throughout the entire tracking of the record assuring all deadlines are met.
  • Coordinates medical record preparation for mailing with the Release of Information Section of the Health Information Management Department.
  • Tracks receipt of all records by the Audit Contractor and assures deadlines are met.
  • Interprets data and provides analysis report of RAC activity to administration.
  • Writes reports in Compliance 360 as well as Excel and manipulates and trends data.
    • Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.
    • Must adhere to DCH Behavorial Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.
    • Requires use of electronic mail, time and attendance software, learning management software and intranet.
    • Must adhere to all DCH Health System policies and procedures.
    • All other duties as assigned
    Minimum Knowledge, Skills, Experience Required Must be able to read, write legibly, speak, and comprehend English. Bachelor's Degree required. Prior healthcare experience related to medical record documentation, charging and billing required. Understanding of The Joint Commission, Centers for Medicare and Medicaid, Medical Staff Rules and Regulations and hospital policies related to documentation requirements for the medical record. Working knowledge of computers and keyboard skills. PC, Windows, and advanced Excel and Word required. Must be able to type 20 words per minute. Must have exceptional organizational skills, be detail oriented and able to effectively handle multiple priorities and deadlines. Excellent verbal/written communication and interpersonal skills, to include diplomacy and respectfulness, in dealing with multiple departments and outside companies. Ability to work independently and as a team member. Must be able to prioritize workload to assure timelines are met at all times. Ability to maintain confidentiality absolutely required.

    Working Conditions Physical presence onsite is essential. Hearing and vision must be normal or corrected to within normal range. Able to perform the duties with or without reasonable accommodation. Requires ability to work 8 hours quietly at a computer screen and keyboard/mouse. Must be able to work well within all levels of the organization. Requires ability to withstand pressures of constant deadlines, audits, educational demands and changing healthcare environment. This job involves standing, walking, sitting, stooping, pushing, pulling, and crouching. Ability to lift up to 20 pounds occasionally and 10 pounds frequently. Must have good dexterity. Should be able to reach and extend arms in any direction. Must be able to meet deadlines as assigned. Ability to communicate verbally and in writing on a daily basis. Ability to work in and lead groups effectively. Ability to make presentations to large groups. Ability to maintain confidentiality. Must be able to adapt to changes in work area as assigned.

    About this company
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    As a community-owned, not-for-profit organization, DCH Health System is committed to providing quality health care services to all residents...