Prospective Chart Review Quality Auditor

• Performs audits of pre-visit medical record reviews to identify chronic conditions reported in prior years and conditions that lack supporting documentation.
• Evaluates suggestions or clinical alerts presented by Prospective Chart reviewers, ensure that these suggestions meet specificity requirements to support clinical indicators and in compliance with Risk Adjustment documentation standards.
• Conducts review and communicates feedback to professionals such as Clinical Chart Reviewers and third-party vendors.
• Responds to questions submitted by Prospective Chart reviewers.
• Document detailed audit findings including all errors and missed opportunities in the Prospective chart reviews.
• Correlate activities, processes and HCC results/ metrics to evaluate outcomes.
• Assist in developing workflows, curriculum and policies and procedures related to the Pre-visit Medical Record review team.

Other Job Functions:

• Understand, adhere to, and implement the Company s policies and procedures.
• Provide excellent customer services skills, including consistently displaying awareness and sensitivity to the needs of internal and/or external clients. Proactively ensuring that these needs are met or exceeded.
• Take personal responsibility for personal growth including acquiring new skills, knowledge, and information.
• Engage in excellent communication which includes listening attentively and speaking professionally.
• Set and complete challenging goals.
• Demonstrate attention to detail and accuracy in work product.

Required Qualifications:

Minimum Experience

• 2+ years of clinical experience required
• 5+ year of chart review and medical coding/auditing experience required
• Advanced level of clinical knowledge associated with chronic disease states required

Education/Licensure:

• Medical doctor or Nurse required
• Coding Certification through AHIMA or AAPC required
• CPC or CPMA preferred

Skills and Abilities:

Ability to be a team player and exercise initiative in responding to provider requests and concerns in a helpful and courteous manner Provider contracting and customer service techniques General understanding of the health care industry, ideally the provider relations field-desired Excellent interpersonal and telephone communication skills are required Exercise attention to detail; ability to provide accurate data entry Ability to work under pressure with minimal supervision, multi-task, complete projects in a timely fashion and meet deadlines a must Excellent analytical, problem solving and organizational skills a must. Language Skills: Strong communication skills both written and verbal to work with multiple internal and external clients in a fast-paced environment Mathematical Skills: Ability to work with mathematical concepts such as probability and statistical inference. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations. Reasoning Ability: Ability to apply principles of logical or scientific thinking to a wide range of intellectual and practical problems. Computer Skills: Ability to create and maintain documents using Microsoft Office (Word, Excel, Outlook, PowerPoint)