Senior Medical Documentation Auditor

Senior Medical Documentation Auditor

The Senior Medical Documentation Auditor works under the direction of the Associate Director of Compliance Programs to support the UNLV Health Compliance Program. The auditor will design and execute audits of medical records, conduct educational training sessions with clinicians based on the audit results, and research and respond to inquiries. Identifies organizational risks and coding trends by performing audits and reviewing analytical data. Educate physicians and clinical staff to improve their medical documentation to be in line with medical record documentation requirements. Develops and executes audits, by applying their technical audit and computer software skills, to prepare accurate and detailed audit reports mitigating liability to the organization.

Candidates must be legally authorized to work in the United States. Please Note: UNLV Health does not provide employment sponsorships or sponsorship transfers for any positions.

Advantages of Working for UNLV Health

• Working Monday through Friday, 8AM to 5PM. (Actual hours may vary depending on business need)
• 12 Full-Day and 2 Half-Day Paid Holidays per year, starting with your first day of employment
• 22 PTO days per year
• 3% 401K Contribution, even if you do not contribute (after 90 days)
• Medical, Dental, and Vision benefits that start the first of the month following your start date

Major Responsibilities

• Plan, develop and execute reviews (i.e., audit, assessments, and investigations) to evaluate the medical records for compliance with established documentation, coverage, coding and billing guidelines.
• Develop and conduct education programs for physicians (i.e., attending, fellows, and residents) and clinical staff (PA, NP/APRN, RN, LPV/LVN, therapists, and medical assistants) on documentation, coverage, coding and billing guidelines.
• Prepare detailed audit reports and documentation to support findings of deficiencies and recommendations for improvements or corrections.
• Ensure the correct application of ICD-10, CPT, and HCPCS codes for diagnoses, treatments, procedures, and services provided.
• Implement corrective actions and educate physicians and clinical staff to improve their medical documentation to be in line with medical record documentation requirements.
• Research and respond to inquiries submitted by providers, coders and administrative staff regarding medical records documentation.
• Act as the compliance liaison with faculty members, developing relationships and functioning as a resource to all providers and their staff relating to audits and results.
• Serve as an institutional subject matter expert and authoritative resource on medical record documentation requirements. Maintains up-to-date information on all the standards set by Medicare, Medicaid, and other entities relating to medical record documentation requirements.
• Analyze audit data to track trends, identify recurring issues, and provide feedback to improve overall coding accuracy.
• Assist with internal and external audits, responding to any documentation/coding-related queries.
• Support the development and implementation of a compliance program that includes regular audits, feedback mechanisms, and policy updates.
• Assist with onboarding new physicians and provide ongoing education to ensure adherence to coding standards.
• Completes any duties and special assignments as requested.

Experience, Education, and Certifications

• Minimum of five (5) years of experience in healthcare compliance, medical coding, and/or related field required or minimum of eight (8) years of experience in lieu of Bachelor's degree.
• High School Diploma or GED equivalency required
• Bachelor's Degree in Business, Healthcare, and/or related field preferred
• Certified Professional Medical Auditor certification (CPMA) required
• Relevant industry certifications (must have at least one):
  • Certified Professional Coder (e.g., AAPC, AHIMA).
  • Certified in Healthcare Compliance (CHC) certification or equivalent.

Knowledge, Skills, and Abilities

• Advanced knowledge and experience conducting Medical Record audits and ability to interpret and apply Federal and State regulations, coding and billing requirements.
• Advanced knowledge and experience in communicating audit results to medical and administrative professionals.
• Advanced knowledge on coding for Multi-Specialty Clinics.
• Advanced experience in training medical and administrative professionals on coding requirements as outlined by CMS.
• Advanced knowledge of HIPAA and other information privacy and security requirements.
• Advanced knowledge of medical diagnostic and procedural terminology.
• Advanced knowledge of outpatient coding practices at both the clinical and inpatient settings.
• Advanced knowledge of compliance and regulatory requirements including outpatient CMS regulations.
• Demonstrated ability to constructively and sensitively provide feedback to providers and medical center leadership regarding federal and state coding, medical documentation and compliance guidelines, audit results and risk areas.
• Must have the aptitude to learn, comprehend and assess complex administrative, clinical and operational processes, and workflow and business arrangements to identify deficiencies, opportunities and risks.
• Must have the ability to be receptive to constructive feedback from internal and external parties in a professional manner.
• Must have the ability to work on special projects as assigned (independently and/or with a team).
• Strong critical thinking, problem solving, and analytical skills.
• Demonstrated proficiency in Microsoft Office (Word, Outlook, Excel, and Power Point).
• Excellent verbal and written communication skills.
• Must be able to work independently with minimal supervision.
• Must be able to work within a team environment.
• Must be able to multitask and prioritize work in a fast-paced environment.
• Must be able to maintain confidentiality.
• Must be able to pay close attention to details.
• Must be able to travel between local facilities and offices as needed for meetings and training.
• Must be able to work on-site.

Physical Requirements

• May include standing, sitting, and/or walking for extended periods
• May include performing repetitive tasks
• May include working on a special schedule (i.e., evenings and weekends)
• May include working with challenging patients and clients
• May include lifting up to 25 pounds

UNLV Health will provide equal opportunity employment to all employees and applicants for employment. No person shall be discriminated against in employment because of race, color, gender, age, national origin, ancestry, religion, physical or intellectual disability, marital status, parental status, sexual orientation, or any other category protected by law.

If you have any questions about our interview and hiring procedures, please contact Recruitment at View email address on click.appcast.io