Clinical Audit Analyst

Clinical Audit Analyst

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation's largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 158 hospital-based locations, in addition to its home-based services and virtual care offerings.

As our Clinical Audit Analyst, you will perform clinical and operational audits to verify the accuracy of information and ensure meticulous compliance with established policies, practices, and regulations.

Every day you will conduct quality reviews of the entire care process, from physician order and registration to chart documentation, charging, billing, and reimbursement. You will also collaborate with revenue integrity advisors for root cause analysis and provide education to departments based on audit findings.

To be successful in this role, you will possess strong analytical and auditing skills, meticulous attention to detail in reviewing clinical and operational data, a deep understanding of healthcare regulations, and the ability to effectively collaborate with various departments to ensure compliance and drive process improvements.

• Perform concurrent, internal and patient requested audits.
• Accurately collects, analyzes, synthesizes, and prepares data and conducts work in a timely manner for use by senior management, service lines, medical staff, and hospital departments.
• Possess and apply broad knowledge of medical field and hospital processes to include, but not limited to medical terminology, medical record documentation/contents, injury/disease processes, and treatment protocol & practices.
• Maintain working knowledge of CPT/HCPC codes and modifiers and appropriate use.
• Recommends improvements for charging and documentation deficiencies, based on analysis and evaluation of revenue/department error trends.
• Maintain working knowledge of federal and state government regulations and advise management of any possible violation so appropriate action can be taken.

Required

• High School Diploma/G.E.D.
• Associate Degree
• 5 years direct patient care in a hospital setting

Preferred

• Cath lab experience, either as an RN, RCIS, or Radiologic Technologist.
• Experience with revenue cycle, billing and coding, EPIC, CUPID, MacLab and Work Queues.
• Familiarity with all Cath Lab, EP, Structural Heart, IR and Vascular Procedures plus CPT codes and physician reports.
• Coding certification and Revenue Cycle Certification
• Bachelor's Degree