Professional Documentation Improvement Auditor
Overview
Ardent Health is a leading provider of healthcare in growing mid-sized urban communities across the U.S. With a focus on people and investments in innovative services and technologies, Ardent is passionate about making healthcare better and easier to access. Through its subsidiaries, Ardent delivers care through a system of 30 acute care hospitals, 24,000+ team members and more than 280 sites of care with over 1,800 affiliated providers across six states. Position Summary The Professional Documentation Improvement Auditor specializes in reviewing and analyzing medical records, claims and workflow processes to ensure accuracy, completeness, and compliance with regulatory requirements. The primary goal is to improve the quality of clinical documentation, which plays a crucial role in patient care, compliance, billing, coding, and reimbursement processes.
Responsibilities
- Using audit tools, authoritative references, CMS and CPT guidelines, bell curves, etc. to analyze for trends, audit providers and coders, and provide education/feedback individually or in a group setting.
- Adhering to policies, procedures and regulations to ensure compliance.
- Audits provider services using auditing tools such as EncoderPro and MD Audit.
- Adheres to provider auditing schedules and audit production standards set by Physician Compliance and Audit Services Director or the Physician Audit Managers.
- Maintains provider scoring results.
- Provides standard documentation on education feedback to providers in a timely manner.
Qualifications
Education and Experience:
- Associate’s Degree
- Additional years of experience may substitute for the required education on a year-for-year basis
- 3+ years auditing experience or 5 years of coding E&M levels of service (multi-specialty, including office visits, preventive services, surgical procedures and hospital inpatient and observation services.
- CPC (Certified Professional Coder) or equivalent certification
- Revenue Cycle experience, preferred.
- Auditing certification (e.g. CPMA-Certified Professional Medical Auditor), strongly preferred.
- Additional specialty specific certifications (e.g. CCC – Certified Cardiology Coder, COBGC – Certified OB/GYN Coder), strongly preferred
- E&M /Procedure/Surgery Auditing/Critical Care/Specialty Specific/Skewed Productivity Curves
- Application and validation of ICD-10 diagnosis codes based on coding guidelines
Knowledge, Skills & Abilities:
- Ability to provide standard documentation on education feedback to providers in a timely manner.
- Ability to perform a trend analysis of provider's bell curves and pull reports accordingly.
- Flexibility to audit specific service lines as needed.
- Flexibility to network with other team members as needed
- Ability to communicate effectively and professionally via email, phone, or Teams messages.
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