HIM Audit Coordinator

# HIM Audit Coordinator Burlington, MA
• Beth Israel Lahey Health
• Full-time
• Day Share job:

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** When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.
** Under direction from the Manger of HIM Audit and Research, is responsible for a variety of third party audits of medical record data for reimbursement, regulatory compliance, quality and appropriateness. Assists in the medical record documentation review for JCAHO compliance, editing of data required by the State Division of Health Care Financing and Policy and other projects/initiatives as necessary.
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* Job Description:

**** Essential

Duties & Responsibilities including but are not limited to:
** 1.
Audit Functions
* Assists the manager of audit in planning and evaluating procedures that support the overall goals and objectives of the HIM Department.
* Prepare & report the status & outcome of the various components of the Audit & Compliance section of HIM
* Serves as a central resource in order to decipher medical conditions, disease processes and terminology.
* Develops & assists w/overseeing adherence to standards for conducting audits and reviews for the HIM Department.
* Works closely with the Director of hospital compliance to support new billing related and audit regulations, regulatory compliance issues confronting the industry & changes in management protocols affecting compliance.
* Assists in the assignment of tasks and helps resolve technical & operational problems.
* Assists in evaluating the impact of solutions to ensure goals are achieved in the audit area as well as the HIM Department as a whole.
* Assists in providing effective direction, effective teamwork & motivation efforts and fosters integration of efforts with system-wide initiatives.
* Coordinates CMS Probe audits.  Researches/analyzes CMS requirement for billing.  Advises Director of Internal Audit and compliance re non-compliant Physician Evaluation and Management coding/documentation.
* Submits/analyzes data necessary for the Federal CERT (Comprehensive Error Rate Testing) program.  Researches and refers issues to Manager and the Director of Internal Audit and Compliance.
* Runs/creates reports from the 3M abstracting system for a variety of users, including the New England Organ Bank, and for verification of data for submission to the State Division of Health Care Finance and Policy.
* Coordinates physician re-credentialing audits as required by Managed Care providers, including provision of appropriate documentation to the auditor and discussion/education of the auditor in Lahey’s practices.  Communicates with the Managed Care Office re issues/requests.
* Trains external and internal auditors in the navigation of a variety of systems necessary for completion of audits, including ECMS/Documentum, LCMC and Dictaphone EXText.
* Responds to request from the Medicare ADR (Advance Developmental Request) program.  Assures location and submission of appropriate documentation within timeframe specified by requestor.  Researchers problems and refers them to the appropriate area.
* Coordinates annual HEDIS (Health Plan Employer Data and Information Set) audits as mandated by Managed Care Plans.  Provides appropriate information to assure that the quality of care at Lahey is appropriately represented in the final results.
* Leads or assists in the performance of audits/projects to assure compliance with JCAHO requirements, Department of Public Health regulations and HRO standards.
* Is directly responsible for the BC/BS Charge audit.  Coordinates retrieval of records/on-line documentation.  Accesses and reviews on-line Billing information.  Discusses issues with the auditor and resolves if appropriate.  Works with…