Purpose:
The Internal Auditor is responsible for conducting regular medical record and coding compliance reviews to ensure that organizational strategies, practices and internal controls are in place and in compliance with all legal and industry regulations.
Regularly reviews appropriate federal and state regulations, industry standard policies and procedures, i.e., CMS, AHIMA, AMA, etc., to ensure compliance
Conducts internal audits, following established protocols, furnishing detailed reports and periodic updates of audit findings, presenting any irregularities or exceptions, as well as pertinent recommendations for improvement, to the Provider, Auditing Supervisor, executive management, the Compliance Committee, Physician Board and others as appropriate
Provides feedback and instruction to the Provider regarding documentation improvements, to include EHR best practices
Essential Duties/Responsibilities:
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Serve as a compliance resource for all coding regulations for provider services
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Assist in formulating policies and procedures regarding coding and documentation to ensure consistency and compliance across all clinic departments
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Interact with Providers and clinic staff to ensure quality and consistency with coding and documentation policies
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Perform quality internal audits
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Education and training of clinic staff and Providers on documentation and coding compliance issues
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Review and update current year procedural and diagnosis codes on an annual basis
Other Duties:
QUALIFICATIONS
Required:
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High school diploma or equivalency
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CCS-P or CPC
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AAPC or AHIMA certification
Preferred:
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Previous auditing experience
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3-5 years of medical coding or documentation experience
Wilmington Health is an Equal Opportunity Employer committed to providing equal opportunities to all applicants and employees. We are committed to treating everyone equally and with respect regardless of race, age, sex, religion, national origin, citizenship, marital status, veteran’s status, sexual preference, disability, genetic information, or any other class protected under state or federal law.
ADA Physical Demands:
Rarely (Less than .5 hrs/day) Occasionally (0.6 – 2.5 hrs/day) Frequently (2.6 – 5.5 hrs/day) Continuously (5.6 – 8.0 hrs/day)
Physical Demand
Required?
Frequency
Internal Auditor Competencies
General
To perform the job successfully, an individual should demonstrate the following competencies:
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Customer Service – Maintains courtesy and diplomacy with all internal and external customers. Makes self-available to respond to customer needs. Prevents unnecessary delays for customers. When necessary, communicates appropriate information to the customer effectively and accurately. Listens effectively. Seeks closure in resolving customer concerns.
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Professionalism/Integrity/Responsibility – Takes responsibility and holds oneself accountable. Displays appropriate work attire, nonverbal messages and office etiquette for the position. Demonstrates flexibility and commitment to professional growth. Has a positive attitude toward his/her work. Promotes respect, honesty, integrity, and fairness to all. Maintains confidentiality regarding patient, business, and employment information. Adheres to organization policies and procedures regarding the Health Insurance Portability and Accountability Act (HIPAA).
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Teamwork/Process Focus – Understands that all parts of the organization must work together. Integrates own activities with the larger group to support the clinic’s objective of providing seamless service to our patients throughout the organization. Voluntarily gives and receives help. Values contributions made by others. Is able to function in a joint cooperative manner while supporting the clinics and departmental plans, programs, policies, procedures, and other team members.
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Dependability/Punctuality – Demonstrates thoroughness in following through on assignments and instructions in a reliable, trustworthy and timely manner. Meets commitments. Adheres to the attendance policy and work schedules. Follows call-in and approval procedure for time off.
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Interpersonal Relationships/Communication – Displays the ability to express ideas clearly, concisely and effectively, both orally and in writing, up, down, and across the organization. Listens well, shares work related information, tolerant of others’ work styles. Ability to work with others in a courteous and effective manner. Exercises authority or the response to criticism in a tactful manner, Interacts and co-operates with others to ensure the clinic’s objectives and goals are met. Resolves conflicts effectively. Promotes departmental teamwork and interdepartmental teamwork. Interacts effectively with supervisor.
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Judgment/Decision Making/Problem Solving – Shows ability to clearly isolate and define problem areas. Considers alternatives and consequences before making decisions. Participates constructively in group problem solving. Presents problems, but suggests timely and practical solutions by using independent thought, originality, and reason. Prioritizes work appropriately.
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Quality/Quantity – Consistently high standard of work while maintaining daily workflow. Work produced by the employee is thorough, accurate, and neat. Displays the ability to work under pressure and learns from previous mistakes.
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Initiative – Demonstrates willingness to make significant contributions with little direction, to be involved in new initiatives and to attempt non-routine jobs and tasks. Displays energy, enthusiasm, ingenuity and versatility. Offers suggestions to solve problems or improve operations. Exercises independent actions within limits of authority.
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Safety and Housekeeping – Observes safety and health regulations; adheres to OSHA guidelines. Adheres to the organization’s Exposure Control Plan and guidelines regarding risk of exposure to bloodborne pathogens. Ensures that a safe work environment is maintained and that work areas are free from hazards. Recognizes and reports any unsafe work practices and/or hazardous conditions to supervisor. Is aware of location of material data sheets and refers to them when necessary. Follows proper procedures on accident reporting. Promotes a professional work environment by maintaining a neat orderly work area free of food and inappropriate visual or written messages.
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Organizational Skills/Time Management – Uses time efficiently in planning, anticipating, and responding. Strives to do things more efficiently. Completes tasks in a timely manner. Keeps supervisor informed of changes in workload.
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Quality Management - Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
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Cost Consciousness - Works within approved budget; Develops and implements cost saving measures; Contributes to profits and revenue; Conserves organizational resources.
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Motivation - Sets and achieves challenging goals; Demonstrates persistence and overcomes obstacles; Measures self against standard of excellence; Takes calculated risks to accomplish goals.
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Innovation - Displays original thinking and creativity; Meets challenges with resourcefulness; Generates suggestions for improving work; Develops innovative approaches and ideas; Presents ideas and information in a manner that gets others' attention.
Department Specific
To perform the job successfully, an individual should demonstrate the following competencies:
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Be available to staff and providers for coding questions.
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Effectively communicate areas of needed improvement to Providers.
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Assist Providers in understanding the importance of solid, compliant documentation.
Special project audits- -i.e., shared visit documentation, Medicare audit requests, and patient complaint audits.
