1. Develops systems and procedures for all government audits, gathers, compiles, organizes and documents relevant audit information.
2. Analyzes, consolidates and interprets audit data.
3. Present audit findings and all other relevant information to Senior Management, and/or the Audit Committee on an as needed basis.
4. Specific knowledge of Medicare Medicaid and commercial payer audit processes and time frames.
5. Delegation of assignments relating to the appeals process to appeal representatives and technical staff.
6. Ensure compliance with all corporate standards and audit regulations as well as all CMS and commercial requirements.
7. Communicate with/educate external entities including the Centers for Medicare and Medicaid Services, Office of Inspector General, commercial payers, appellants and their authorized representatives.
8. Communicate effectively. This position displays effective communication skills while performing the following functions:
- Verbal and written communication with Director and senior leadership, peers, departmental staff, and various corporate support departments
- Verbal and written communication with external business partners including vendors, payer representatives, Recovery Audit Contractors (RAC), Qualified Independent Contractors (QIC) and Medicare/Medicaid representatives
- Verbal and written communication with our customers including the Centers for Medicare and Medicaid Services (CMS), providers, and beneficiaries.
9. Identify opportunities, using Medicare policies and procedures, claims processing procedures and related data processing systems, to improve overall performance.
10. Coordinate activities and exchange of information with external business partners
11. Recommend, coordinate and initiate improvements to the process to achieve efficiency, cost reduction, productivity, and quality gains
12. Effectively utilizes audit tools. Utilizes with increasing proficiency, proprietary reports, tools and systems required to perform duties. With moderate guidance and direction,
timely executes assigned standard reports and updates. Working proficiency with all systems and applications including Decipher and client tools.
13. Coordinate provider education activities
14. Provide feedback to management on the status of audits in their section to ensure the department contributes toward the department meeting and exceeding all performance standards
15. Challenges current working practices; identifies process improvement opportunities and presents recommendations and solutions to management. Engages and commits to the organization’s culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence.
