May identify/make recommendations to management for supplemental team/concept type training. May support training material/tools and best practices development. Proactively contributes to continuous improvement of activities and sets positive exampleĬontributes collaboratively to identifying opportunities for improvement of audit results and continuous improvement initiatives. Successfully completes, retains, applies, and adheres to content in required training as assigned that includes but not limited to information security, anti-harassment and other compliance and policy/procedures training applicable for position. Participates in and contributes to applicable department meetings. Maintain current knowledge and changes that affect our industry and clients as it pertains to medical practice, technology, regulations, legislation, and business trends. May prepare qa reports for management that includes a variety of data and trends at the individual, department, and client program level, as well as date range or concept based/trended, or other characteristic that will provide valuable business insights.Ĭonsults with internal resources as necessary.īecome subject matter expert for assigned business segment(s). Monitors, tracks, and reports on all work conducted in accordance with qa process and management direction. May perform primary audit activity as assigned by management May support findings during the appeals process, if needed. Provides correction to narrative rationale to correspond with audit determination and flags patterns of concern to audit leadership for real-time intervention, preventing an accumulation of improper findingsĬontributes to the continuous improvement feedback process and suggests or makes any edits, documentation, next steps, and reporting as may be necessary in accordance with department process and audit leadership direction. Reviews audit documentation and conducts research, analyzes claims data, applies knowledge of client sow, applicable concept guidelines, policies, and regulations as necessary to determine if audit result is accurate and includes complete details to support findings. Objectively and accurately documents quality review results in accordance with department quality policies and procedures, scoring and reporting all qa results in an approved qa tracking system and routes record appropriately within audit platform based upon how qa review resulted in concurrence with audit finding or identified corrections required. Performs limited volume of outpatient coding reviews on medical records to maintain subject matter expertise, and additionally as needed to support business needs.Ĭonducts quality assurance reviews on medical review audit work completed by the medical review coding audit team members, maintaining productivity and quality standards as defined by department policy.
The medical review coding qa auditor (outpatient) is responsible for conducting quality assurance (“qa”) reviews of medical review audit work completed by the medical review coding audit team members to ensure the accuracy of claim findings and applicable documentation for our clientsCommunicates and supports the identification of potential training opportunities or enhancements to training and/or concept review guideline materials and toolsResponsible for performing some audit activity and consistently achieves or exceeds productivity goals and quality standardsServes as subject matter expert, provides supplemental escalation support, and may perform special project activity as needed.
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