Job Title: Discharge Panel Patient File - Medical Auditor
Job Objective:
To perform comprehensive audits of patient discharge and dispatch files to ensure clinical, billing, and documentation accuracy and justification. The goal is to ensure compliance with medical necessity, optimize claim approvals, prevent revenue leakage, and identify discrepancies or overutilization from a payor perspective.
Key Responsibilities:
1. Discharge Summary Audit
- Verify that procedures performed, clinical outcomes, and drugs used are clearly and accurately documented.
- Ensure justification of High-Cost Drugs is backed by corresponding investigations and documented in the discharge summary.
- Check for consistency between treatment notes, discharge summary, and final billing.
- Confirm final diagnosis aligns with admission indication and clinical course.
2. Admission Justification Audit
For Emergency Admissions:
- Confirm that clinical reason for the ER visit is clearly documented in both the Admission Form and Discharge Summary.
- Ensure supporting investigations (labs/imaging) justify the emergency admission.
- Review ER doctor notes for adequate justification of urgent care or hospital admission.
For Regular Admissions:
- Validate presence of referral documentation and clear admission indication.
- Confirm admission aligns with diagnosis, planned treatment, and patient symptoms.
3. Clinical Course of Stay
- Ensure chronological recording of treatments, investigations, consultations, and progress notes.
- Validate inter-department referrals or cross-specialty care based on clinical necessity.
4. OT Notes Audit
- Cross-check OT notes with billed surgery codes and documentation.
- Ensure details of surgery performed match approval/referral and billed procedure.
- Verify use of any implants/consumables is mentioned in Doctor Notes and approval for the same is in place.
5. ICP Review
- Review daily progress notes, nursing documentation, consultant visits, and any critical events.
- Ensure alignment of ICP, clinical notes, and final discharge summary.
- Detect variations in care plan without justification.
6. Implant/Procedure Approval
- For any Unlisted Implant / Procedure, Verify presence of ECHS/CGHS approval.
- Match billed amount with sanctioned approval.
- Ensure supporting clinical justification and documentation are present.
7. Investigation Justification
- Cross-check major investigations (CT/MRI/USG/Echo) for relevance to diagnosis or symptoms.
- Identify and flag overuse, repeated, or irrelevant tests without supporting documentation or outcome value.
Key Skills & Competencies:
- Strong understanding of clinical documentation, hospital billing, and protocols.
- In-depth knowledge of CGHS/ECHS policies & documentation.
- Strong communication and reporting skills.
- Integrity and discretion in handling sensitive medical and financial data.
Educational Qualifications:
- BDS / BAMS / BHMS / or Allied Health Graduate with experience in clinical auditing.
Experience Required:
- Minimum 35 years of experience in hospital patient file audits, medical review.
Interested Candidates kindly forward your resume at amandeep.kaur@livasahospitals.in or can connect at 7743005537
ob Title: Discharge Panel Patient File - Medical Auditor
Job Objective:
To perform comprehensive audits of patient discharge and dispatch files to ensure clinical, billing, and documentation accuracy and justification. The goal is to ensure compliance with medical necessity, optimize claim approvals, prevent revenue leakage, and identify discrepancies or overutilization from a payor perspective.
Key Responsibilities:
1. Discharge Summary Audit
- Verify that procedures performed, clinical outcomes, and drugs used are clearly and accurately documented.
- Ensure justification of High-Cost Drugs is backed by corresponding investigations and documented in the discharge summary.
- Check for consistency between treatment notes, discharge summary, and final billing.
- Confirm final diagnosis aligns with admission indication and clinical course.
2. Admission Justification Audit
For Emergency Admissions:
- Confirm that clinical reason for the ER visit is clearly documented in both the Admission Form and Discharge Summary.
- Ensure supporting investigations (labs/imaging) justify the emergency admission.
- Review ER doctor notes for adequate justification of urgent care or hospital admission.
For Regular Admissions:
- Validate presence of referral documentation and clear admission indication.
- Confirm admission aligns with diagnosis, planned treatment, and patient symptoms.
3. Clinical Course of Stay
- Ensure chronological recording of treatments, investigations, consultations, and progress notes.
- Validate inter-department referrals or cross-specialty care based on clinical necessity.
4. OT Notes Audit
- Cross-check OT notes with billed surgery codes and documentation.
- Ensure details of surgery performed match approval/referral and billed procedure.
- Verify use of any implants/consumables is mentioned in Doctor Notes and approval for the same is in place.
5. ICP Review
- Review daily progress notes, nursing documentation, consultant visits, and any critical events.
- Ensure alignment of ICP, clinical notes, and final discharge summary.
- Detect variations in care plan without justification.
6. Implant/Procedure Approval
- For any Unlisted Implant / Procedure, Verify presence of ECHS/CGHS approval.
- Match billed amount with sanctioned approval.
- Ensure supporting clinical justification and documentation are present.
7. Investigation Justification
- Cross-check major investigations (CT/MRI/USG/Echo) for relevance to diagnosis or symptoms.
- Identify and flag overuse, repeated, or irrelevant tests without supporting documentation or outcome value.
Key Skills & Competencies:
- Strong understanding of clinical documentation, hospital billing, and protocols.
- In-depth knowledge of CGHS/ECHS policies & documentation.
- Strong communication and reporting skills.
- Integrity and discretion in handling sensitive medical and financial data.
Educational Qualifications:
- BDS / BAMS / BHMS / or Allied Health Graduate with experience in clinical auditing.
Experience Required:
- Minimum 3 to 5 years of experience in hospital patient file audits, medical review.
Interested Candidates kindly forward your resume at amandeep.kaur@livasahospitals.in or can connect at 7743005537
