Audit Professional - Health Information

Audit Professional 2 - Health Information - FT Days Who We Are

UCI Health is the clinical enterprise of the University of California, Irvine, and the only academic health system based in Orange County. UCI Health is comprised of its main campus, UCI Medical Center, a 459-bed, acute care hospital in Orange, Calif., four hospitals and affiliated physicians of the UCI Health Community Network in Orange and Los Angeles counties and ambulatory care centers across the region.

Listed among America’s Best Hospitals by U.S. News & World Report for 23 consecutive years, UCI Medical Center provides tertiary and qua ternary care and is home to Orange County’s only National Cancer Institute‑designated comprehensive cancer center, high‑risk perinatal/neonatal program and American College of Surgeons‑verified Level I adult and Level II pediatric trauma center, gold level 1 geriatric emergency department and regional burn center.

UCI Health serves a region of nearly 4 million people in Orange County, western Riverside County and southeast Los Angeles County.

• Incumbent is responsible for conducting both concurrent and retrospective audits of medical records to ensure the presence and timeliness of clinical information as defined by the Medical Staff General Rules and Regulations, Title 22, Medicare’s Conditions of Participation and Joint Commission requirements.
• Reviews records for evidence of documentation of medical necessity criteria in response to payment denials/chart requests from insurance companies.
• Compiles data of the findings from the reviews and prepares reports for the Director for presentation at various committee meetings.
• Analyzes and identifies patterns and trends to identify opportunities for improvement.
• Participates in physician and other health care providers education to facilitate documentation within the medical record.
• Assists with the coordination of the forms committee to ensure forms content is compliant with outside regulatory requirements.
• Assists with other medical record related functions as required or assigned.

• Must possess the skill, knowledge and ability essential to the successful performance of assigned duties.
• Must demonstrate customer service skills appropriate to the job.
• Extensive knowledge of Joint Commission physician documentation requirements, Medicare’s Conditions of Participation, Title 22 documentation requirement and Medicare’s National and Local Coverage Determination Medical Necessity requirements for procedure performance.
• Excellent written and verbal communication skills in English.
• Demonstrated knowledge of medical terminology.
• Demonstrated experience with database information retrieval and analysis.
• Demonstrated ability to compare data from a variety of sources and accurately identify variances or discrepancies in the data.
• Attention to details with the ability to troubleshoot and pursue problems to satisfactory resolution.
• Analytical skills to identify problems, conduct research, analyze data and determine solutions.
• Advanced computer skills to include navigation and operation of MS office products (Word, Excel, PowerPoint, Access), with the ability to run various reports.
• Ability to understand and correctly interpret clinical documentation contained in an electronic medical record.
• Ability to maintain a work pace appropriate to the workload.
• Ability to establish and maintain effective working relationships across the Health System.
• 5 years previous experience working with an electronic health record system.

• Working knowledge of EPIC electronic health record.
• Knowledge of University and medical center organizations, policies, procedures and forms.

We offer a wealth of benefits to make working at UCI even more rewarding. These benefits may include medical insurance, sick and vacation time, retirement savings plans, and access to a number of discounts and perks.

The University of California, Irvine (UCI) seeks to provide a safe and healthy environment for the entire UCI community. As part of this commitment, all applicants who accept an offer of employment must comply with the…