Inpatient Physician Auditor
SCIO’s team of more than 800 global professionals are bound through a shared commitment to excellence with the purpose of enabling our clients to positively shape the healthcare world by delivering actionable outcomes. We currently serve over 60 clients including several of the leading healthcare organizations.
The Inpatient Physician Auditor would review the medical records and render the appropriate decision based on established criteria exercising independent decision making and judgement using advanced knowledge on a regular basis. The Inpatient Physician reviewer would also support the clinical staff and ensure that they are well trained and supported in their daily duties.
Responsibilities and Duties:
Review medical records to verify services were provided and charges are accurate. Identify if a discrepancy exists and document the findings using standard documentation guidelines applicable to the program. Meet the productivity and quality goals of the program consistently
Collects random quality samples of work performed by clinical staff from time to time to assess their effectiveness and/or improvement opportunities
Report any problems in the audit process to Manager for resolution
Uses/Reference tools to ensure that selection focus/criteria is effective, relevant, and fresh, working with clinical staff to stay abreast of issues.
Analyzes issues (or inappropriate actions, such as unapproved templates, practices, or performance issues that put the program’s quality or client relationship at risks).
Works with production staff to assess, improvement, plan, and execute strategies at the program or division level.
MD will also support production staff when needed on client calls, new implementations or RFP
Work on escalated claims and appeals and validate the initial decision
Comply with HIPAA and other regulations regarding the confidentiality of patient information
Knowledge and Skills:
Experience with need programs such as: Excel, PowerPoint, Outlook, and Word
Experience with MCG and Interqual care guidelines
Sound knowledge of ICD-9, ICD-10, CPT and HCPCS coding guidelines
Doctorate of Medicine
Minimum of 5 years diverse clinical experience
Previous auditing experience internal or external