General Summary of Position
Responsibility for independently performing CDI, inpatient and outpatient coding/billing audits and other projects as assigned by the Vice President of Internal Audit (IA) or the Senior Audit Manager, IA. Such work includes, but is not limited to, completing audits for the organization to ensure controls are in place and functioning as intended. This will be accomplished by assessing risks, analyzing controls, and ensuring that business practices are effective, efficient, and compliant with MedStar policies and regulatory requirements. Demonstrates a thorough understanding of complex inpatient and outpatient coding and billing concepts,(including MS-DRGs, ICD-9-CM, ICD-10-CM, ICD-10-PCS, CPT, E&M, Modifiers), CDI compliance with REGS.DOC.001- REGS.DOC.004, and auditing concepts; discusses complex coding, CDI, and auditing issues with IA and client management; keeps informed of professional standards and company/department policies and procedures and effectively applies this knowledge to complex client situations.
Primary Duties and Responsibilities
Contributes to the achievement of established department goals and objectives, and adheres to IA department policies, procedures, quality standards and safety standards. Complies with governmental and accreditation regulations. Embodies and demonstrates the Mission, Vision and Spirit Values of MedStar.Analyzes findings to identify root causes. Communicates ideas appropriately, develops recommendations, and participates in the preparation of audit reports and presentations to management.Develops audit programs and working papers detailing audit procedures/techniques executed in complex, judgmental and specialized areas of inpatient and outpatient coding and billing and clinical documentation improvement. Obtains adequate audit evidence in accordance with IA department and professional standards.Plans and performs audits according to the Annual Internal Audit Plan.Provides innovative and creative ideas to formulate new audit and risk assessment approaches.Stays abreast of general industry, regulatory and economic developments and applies their understanding to identify areas of audit significance, assesses the degree of risk and the nature of the errors that could result from coding and billing errors, identifies unusual or unexpected transactions and processes, and demonstrates a broader understanding by recognizing business trends and emerging technical and industry developments of relevance to share with the client engagement team.Uses Computer-Assisted Audit Techniques (CAAT) as appropriate on projects.Participates in meetings and on committees and represents the department and hospital in community outreach efforts. Participates in multi-disciplinary quality and service improvement teams.Performs other duties as assigned.
Minimum Qualifications
Education
- Bachelor's degree in Health Information Management required or
- Accounting. required
Experience
- 3-4 years 4 years health information management coding experience in an acute care setting; experience with computer systems for encoding and abstracting required and
- Auditing experience preferred
Licenses and Certifications
- Certified as a RHIT (Registered Health Information Technician) or RHIA (Registered Health Information Administrator), with CCS (Certified Coding Specialist) required
Knowledge, Skills, and Abilities
- Proficient in 3M encoder/grouper, Microsoft Word, Excel and/or Access, PowerPoint.
- Excellent interpersonal skills, including verbal and written communication.
- Good public speaking and presentation skills.
- Experience with data analysis / computer assisted audit techniques (CAAT) and tools and audit management software is a plus.
Why MedStar Health?
At MedStar Health, we understand that our ability to treat others well begins with how we treat each other. We work hard to foster an inclusive and positive environment where our associates feel valued, connected, and empowered. We live up to this promise through:
- Strong emphasis on teamwork - our associates feel connected to each other and our mission as an organization. In return, our effective team environment generates positive patient outcomes and high associate satisfaction ratings that exceed the national benchmark.
- Strategic focus on equity, inclusion, & diversity - we are committed to equity for all people and communities. We continue to build a diverse and inclusive workplace where people feel a sense of belonging and the ability to contribute to equitable care delivery and improved community health outcomes at all levels of the organization.
- Comprehensive total rewards package - including competitive pay, generous paid time off, great health and wellness benefits, retirement savings, education assistance, and so much more.
- More career opportunities closer to home - as the largest healthcare provider in the Baltimore-Washington, D.C. region, there are countless opportunities to grow your career and fulfill your aspirations.
About MedStar Health
MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It's how we treat people.
MedStar Health is an Equal Opportunity (EO) Employer and assures equal opportunity for all applicants and employees. We hire people to work in different locations, and we comply with the federal, state and local laws governing each of those locations. MedStar Health makes all decisions regarding employment, including for example, hiring, transfer, promotion, compensation, benefit eligibility, discipline, and discharge without regard to any protected status, including race, color, creed, religion, national origin, citizenship status, sex, age, disability, veteran status, marital status, sexual orientation, gender identity or expression, political affiliations, or any other characteristic protected by federal, state or local EO laws. If you receive an offer of employment, it is MedStar Health's policy to hire its employees on an at-will basis, which means you or MedStar Health may terminate this relationship at any time, for any reason.
