CHART AUDITOR

Chart Auditor

JPS Health Network is a $950 million, tax-supported healthcare system in North Texas. Licensed for 582 beds, the network features over 25 locations across Tarrant County, with John Peter Smith Hospital a Level I Trauma Center, Tarrant County's only psychiatric emergency center, and the largest hospital-based family medical residency program in the nation. The health network employs more than 7,200 people.

Job Summary: The Chart Auditor will be responsible for performing clinical reviews to determine the accuracy of ICD-10 codes listed on forms from payors, performing interactive outreach for the Transition of Care program, pending outstanding patient orders, validating ED high utilization patient attribution, and reviewing gap in care reports to address outstanding patient health risks. This job involves accessing proprietary systems to audit medical records, accurately documenting findings, and providing forms to the clinic providers.

Essential Job Functions & Accountabilities:

1. Reviews and interprets medical records and compares against forms for accuracy of presumed diagnoses.
2. Documents decisions and rationale to justify review findings.
3. Pend orders to address outstanding patient care gaps.
4. Performs interactive outreach for patients discharged from Inpatient stays.
5. Assists management with training any new Chart Auditor.
6. Maintains current knowledge of clinical criteria guidelines to maintain a clinical license.
7. Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.
8. Actively cross-trains to perform reviews of multiple payor types and requirements and understand the documentation needs.
9. Recommends, tests, and implements process improvements, new audit concepts, and technology improvements that will enhance production, quality, and client satisfaction.
10. Reviews payor gap in care reports to validate patient medication adherence compliance.
11. Validates and facilitates care management for high ED utilizing patients.
12. Job description is not an all-inclusive list of duties and may be subject to change with or without notice. Staff are expected to perform other duties as assigned.

Required Qualifications:

• Completion of relevant education or training as a Licensed Vocational Nurse (LVN), Nursing (RN), or related field of study from an accredited college, university or vocational/training school.
• If applicable, associated licensure/certification to education (i.e. LVN).
• 2 plus years of clinical experience.

Preferred Qualifications:

• Bachelor's Degree in Nursing from an accredited school of professional nursing.
• 2 plus years of claims auditing or value-based care work.

Location Address: 200 W. Magnolia Fort Worth, Texas, 76104 United States