External Audit

Position Overview

External Audit Support professional specializing in the submission of medical necessity for post and prepayment audits in all lines of business, plays a crucial role in ensuring compliance with regulatory standards and optimizing reimbursement for services provided. Primary responsibility is to assess medical records, documentation, and care plans to support the necessity and appropriateness of services rendered in all lines of business.

Additionally, the professional collaborates with interdisciplinary teams to facilitate accurate and timely submission of audit‑related documentation, while adhering to industry guidelines and regulations.

• Conduct thorough reviews of medical records, including physician orders, nursing notes, therapy documentation, and other pertinent information to assess the medical necessity of services in order to submit responses to audits requested by any payer or external audit agency.
• Ensure timely submission of initial requests and any subsequent appeals.
• Collaborate with internal clinical support teams to relay and educate on any trends in denials.
• Support tracking and reporting of external audits by vendor and campus to provide the status of Medical Records retrieval, submission/acceptance of documentation, denial/appeal management, recoupment, and file closure.
• Review patient assessments, treatment plans, and progress notes to ensure alignment with established care standards and regulatory requirements.
• Collaborate with healthcare providers, including physicians, nurses, therapists, and other members of the healthcare team, to gather additional information and clarify documentation as needed.
• Utilize clinical knowledge and expertise to identify potential gaps or discrepancies in documentation that may impact the reimbursement process or compliance with regulatory standards.
• Stay abreast of changes in healthcare regulations, reimbursement policies, and industry best practices related to medical necessity criteria.
• Participate in educational initiatives and training programs to enhance understanding of documentation requirements and promote compliance among staff members.
• Maintain confidentiality and integrity of patient information in accordance with HIPAA regulations and organizational policies.
• Provide support and guidance to staff members involved in the documentation and billing processes, offering education and training as needed to ensure accuracy and consistency.
• Collaborate with internal and external auditors, payers, and regulatory agencies during audits and reviews, serving as a resource and subject matter expert on medical necessity criteria and documentation standards.
• Other duties as assigned.

Education:

Associate Degree

Experience:

3-5 years

• Active Registered Nurse (RN) license preferred.
• Active Licensed Practical Nurse (LPN) license with minimum experience of 3-5 years required.
• Active Therapy (OT/PT/SLP) license preferred.

Sitting, standing, bending, reaching, stretching, stooping, walking, and moving intermittently during working hours. Must be able to lift at least 50 lbs. Must be able to maintain verbal and written communication with co‑workers, supervisors, residents, family members, visitors, vendors, and all business associates outside of the health campus.

US-KY-Louisville 303 N. Hurstbourne Parkway, Louisville, KY

• Competitive salaries and weekly pay
• 401(k) Company Match
• Mental Health Support Program
• Student Loan Repayment and Tuition Reimbursement
• Health, vision, dental & life insurance kick in on the first of the month after your start date
• First time home buyers' program
• HSA/FSA
• And so much more!

As one of Fortune's Best Places to Work in Aging Services, a certified Great Place to Work, and one of Glassdoor's Top 100 Best Companies to Work, Trilogy is proud to be an equal opportunity employer committed to helping you reach your full potential and diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy or any other protected characteristic as outlined by federal, state or local laws.

FOR THIS TYPE OF EMPLOYMENT STATE LAW REQUIRES A CRIMINAL RECORD CHECK AS A CONDITION OF EMPLOYMENT.