Regulatory Audit Consultant

Recruiter
Altegra Health
Location
Canada
Salary
Competitive salary
Posted
16 Sep 2020
Closes
17 Sep 2020
Ref
1153
Job role
Audit
REGULATORY AUDIT CONSULTANT

The Regulatory Audit Consultant is a regional Health Information Management (HIM) employee responsible for supporting and processing of regulatory audit related requests for medical and billing records, as well as monitoring the accuracy of hospital medical record releases; tracks and monitors the timeliness for processing Recovery Audit Contractor (RAC) and other regulatory audit requests, as well as processing the appeals cases to ensure compliance and adherence to the requirements defined by the Centers for Medicare and Medicaid Services (CMS); conducts pre-audits prior to the submission of medical records requested for audits by regulatory agencies; functions as the liaison between the Region and local facilities during the record submission and appeals periods; and through the final closure of the audited cases; coordinates and schedules the Regional RAC Steering Committee meetings and the regulatory audit workgroups(s); participates in the release of information committee and workgroups; prepares and distributes detailed reports related to regulatory audit activities in the region.

Major Responsibilities/Essential Functions * (In order of importance, list primary job duties this position is responsible for achieving. Each statement should relate to an end result or objective.) Estimated % of Time Spent
1. Coordinates and supports the production of regulatory audit related requests for hospital medical records, working collaboratively with the local facilities, the region and the regulatory agencies. 30%

2. Monitors and audits the accuracy of the hospital medical record releases. 10%
3. Monitors and tracks the appeals process and audit outcomes; including the preparation of documentation needed for any regulatory audit appeals. 5%

4. Implements work flows and monitors the accuracy and the timely completion and submission of medical records in compliance with CMS requirements. 5%

5. Participates in regional regulatory audit meetings and coordinates the workgroups, including preparing agenda items, drafting minutes and following up on action items identified during the RAC Steering Committee. 10%

6. Tracks all regulatory audit activities across the Northern California region and maintains the regulatory audit tracking tool. 5%

7. Monitors and ensures that the complete and compliant medical record is submitted to the requesting regulatory agency within the required timeframe. 5%
8. Prepares and distributes accurate, timely, complete and detailed reports and statistics on all regulatory audit activities across the Northern California region. 5%
9. Ensures compliance with federal, state and local regulations as it relates to regulatory audits and release of information. 15%
10. Maintains current knowledge of local, state and federal regulations as it relates to regulatory audits and release of information.
5%
11. Consistently supports compliance and the Principles of Responsibility (client code of conduct) by maintaining confidentiality, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable Federal and State laws and regulations, accreditation and licensure requirements, and client policies and procedures.
2%

12. Other duties as assigned. 3%
Total 100%

NO MEDICAL SCREENING
NO TRAVEL
NO DIRECT REPORTS
# OF TEAM MEMBERS, 3
TOP 3 SKILLS: COMPUTER AND SOFTWARE SKILLS, KNOWLEDGE OF EPIC, KNOWLEDGE OF MEDICAL RECORDS
TOP 5 DAILY RESPONSIBILITIES: TRACKING AND MONITORING REGULATORY AUDI REQUESTS, PROCESSING APPEALS, UPDATING THE TRACKING TOOL WITH NEW INFORMATION, CONDUCT RELEASE OF INFORMATION AUDITS, GENERATE REPORTS
TOP 3 PERSONALITY TRAITS: ABLE TO WORK INDEPENDENTLY, ABILITY TO DEAL WITH A FAST PACE WORK ENVIRONMENT, ABILITY TO MEET DEADLINES WITHOUT CONSTANTLY BEING MONITORED BY MANAGER.