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Chart Auditor/CDM Management in Santa Fe Springs, CA at Avanti Hospitals

Date Posted: 4/26/2019

Job Snapshot

Job Description

Central Business Office

Job Title: Chart Auditor/CDM Management 

City: Santa Fe Springs / State: California    

Central Business Office

Day Shift

From 8:00 AM

To 4:30 PM

                                      


Job Description and Job Responsibilites

Job Title: Chart Auditor/CDM Management


Job Summary:
The Chart Auditor must work with a diverse group of health care professionals to conduct billing and coding audits related to health plans and patient complaints. They must review medical records to assure all charges are supported by clinical documentation. Has knowledge of commonly used concepts, practices, and procedures within Patient Accounting, Patient Access, to include CDM management and assists in identifying and selecting possible system solutions. Chart Auditor must have knowledge of government/State policies. The position will be responsible to work with ancillary departments to review, update, and manage the proper codes and description in the CDM. The auditor should have strong project management and analytical skills and be able to handle projects simultaneously. Additionally they should be strongly detail-oriented. This auditor should be able to work well individually or as part of a team. Reports to CBO Director


Essential Job Duties:
 Performs chart audits on high dollar claims.
 Performs Defense audits with outside payors
 Reviews and discusses charges in dispute with patients
 Identifies under and over charges
 Documents findings in financial systems and in report excel format
 Works correspondence pertaining to audits
 Communicates with Billing and Collections departments, and other Revenue Cycle departments.
 Assist with clinical denials and the appeal process
 Responsible to work with ancillary departments to review, update, and manage the proper codes and description in the CDM.
 Creatively applies job knowledge and experience to solve difficult problems and regularly provides suggestions for quality improvement.
 Works with Leadership to recommend ways to maximize the use of the department to support strategic and operational needs of the Hospital.
 Works with Leadership to identify training and system gaps and develop strategies to address these gaps.
 Maintains regular user contact, attends relevant meetings and functions as a point of contact for problem resolution as needed.
 Undertakes ad-hoc assignments as required so as to react quickly and positively to new or emergent situations.
 Leads and participates in project teams.
 Complies with Federal, State, and Local Laws that govern business practices.
 Performs all other duties as assigned


Behavioral Standards:
 Exhibits customer and service oriented behaviors in every day work interactions.
 Demonstrates a courteous and respectful attitude to internal workforce and external customers.
 Communicates accurately and appropriately.
 Works well and efficiently under minimal supervision.
 Handles difficult situations in a discreet and professional manner.
 Demonstrates a willingness to act as a representative of the hospital.
 Maintains a good attendance record.
 Adheres to timekeeping procedures at all times.
 Is adaptable to changes in assignments and priorities.


Communication/Knowledge:
 Provides accurate and timely written and verbal communication of information in a manner that is understood by all.
 Able to listen, understand, problem-solve, and carry-out duties to ensure the optimal outcome.
 Able to use IT systems in an accurate and proficient manner.


Collaboration/Teamwork:
 Contributes toward effective, positive working relationships with internal and external colleagues.
 Demonstrates cooperation, flexibility, reliability, and dependability in all daily work activities and a willingness to collaborate with others for the good of the customer and the organization.






Job Requirements

Education/Experience:
 Two or more years in a college program in healthcare; or 3-5 years of experience and/or training; or equivalent combination of education and experience. Bachelors preferred.
 Three or more years of Clinical related work experience in an acute care hospital. LVN or RN preferred. Patient Financial Services setting preferred.
 Good written and oral communication skills, training in business functions and analysis.
 Good analytical, logical thinking and problem-solving skills, as well as critical thinking skills.
 Excellent interpersonal skills.


Licensure/Certifications:
 LVN or RN preferred
ADA/Physical Demands:
 To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant in order to be considered.
 Required to stand; walk; sit; use hands to fingers, handle, or feel; reach with hands and arms; stoop, kneel, crouch, or crawl; talk and hear; and may taste and smell. The employee is regularly required to lift, push and/or pull weights in excess of 10 pounds, with assistance. Visual abilities, auditory abilities, must be intact to perform duties.

 

Job Requirements

Education/Experience:
 Two or more years in a college program in healthcare; or 3-5 years of experience and/or training; or equivalent combination of education and experience. Bachelors preferred.
 Three or more years of Clinical related work experience in an acute care hospital. LVN or RN preferred. Patient Financial Services setting preferred.
 Good written and oral communication skills, training in business functions and analysis.
 Good analytical, logical thinking and problem-solving skills, as well as critical thinking skills.
 Excellent interpersonal skills.


Licensure/Certifications:
 LVN or RN preferred
ADA/Physical Demands:
 To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant in order to be considered.
 Required to stand; walk; sit; use hands to fingers, handle, or feel; reach with hands and arms; stoop, kneel, crouch, or crawl; talk and hear; and may taste and smell. The employee is regularly required to lift, push and/or pull weights in excess of 10 pounds, with assistance. Visual abilities, auditory abilities, must be intact to perform duties.