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About The Position
The Senior Medical Documentation Auditor works under the direction of the Chief Compliance Officer 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 the audit results, and research and respond to inquiries. Identifies organizational risks and coding trends by performing audits and reviewing analytical data. Educate physicians and clinical staff to improve their medical documentation to be in line with medical record documentation requirements. Develops and executes audits, by applying their technical audit and computer software skills, to prepare accurate and detailed audit reports mitigating liability to the organization.
Candidates must be legally authorized to work in the United States. Please Note: UNLV Health does not provide employment sponsorships or sponsorship transfers for any positions.
Requirements
- Bachelor’s Degree in Business, Healthcare, and/or related field preferred
- Minimum of five (5) years of experience in healthcare compliance, medical coding, and/or related field required or minimum of seven (7) years of experience in lieu of Bachelor’s degree
- High School Diploma or GED equivalency required
- Certified Professional Medical Auditor certification (CPMA) required
- Certified Professional Coder (e.g., AAPC, AHIMA).
- Certified in Healthcare Compliance (CHC) certification or equivalent.
- Advanced knowledge and experience conducting Medical Record audits and ability to interpret and apply Federal and State regulations, coding and billing requirements
- 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
- Must have the aptitude to learn, comprehend and assess complex administrative, clinical and operational processes, and workflow and business arrangements to identify deficiencies, opportunities and risks
- Strong critical thinking, problem solving, and analytical skills
- Demonstrated proficiency in Microsoft Office (Word, Outlook, and Excel)
- 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
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 and billing practices.
- Act as the compliance liaison with faculty members, developing relationships and functioning as a resource to all providers and their staff relating to documentation, coding and billing audits and results.
- Serve as an institutional subject matter expert and authoritative resource on medical record documentation requirements.
- Maintains up-to-date information on all the 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.
- Review clinical documentation and verify the accuracy of CPT/HCPCS and ICD-10 codes. Monitor regulatory and reimbursement updates to ensure organizational compliance.
- Participate in special assignments and compliance initiatives as requested by leadership.
- Provide onboarding education for new physicians and ongoing training to ensure continued compliance with current standards.
Benefits
- 12 Paid Holidays per year, starting with your first day of employment!
- 20 + PTO days per year! (Depending on Position)
- 3% 401K Contribution, even if you do not contribute!
- Medical, Dental, and Vision benefits that start the first of the month following your start date!