code auditor

Location: Lansing, Michigan
Posted On: 9/13/2017
Job Code: 1000093754
Job Description
This project will involve training, education, review of records to encompass a variety of initiatives. The nurses and coders will be expected to participate in provider and hospital visits to educate, train and review medical records to determine the following:
- Verify and help providers close treatment opportunities
- Assist and train providers on how to close diagnoses gaps
- Train providers on the use of HEB
- Perform clinical reviews with knowledge of body systems, anatomy and physiology.
- Scan records as required
- Generate summary of activity as requested
- Develop and maintain an effective professional working relationship with providers.
- Contact or answer questions (educate) for iproviders

In addition, contractors may be asked to work on cases involving:
- Appropriateness of documentation for select conditions
- Proper coding of the patients condition
- Physician signature requirements are met
- Patient identification documented in the medical records.
- Assist other departments, consultants when visiting providers to discuss a variety of HEDIS/Stars related issues not limited to high risk medications for example
- Conduct other activities as assigned which may include other initiatives beside RMRA and Stars
- Other duties may be assigned.

Must have a valid RN license
RN with HEDIS experience but will interview qualified RN.
RN with certified professional coding is a plus.

R.N. licensed in Michigan; minimum Associate degree acceptable with a minimum 5 years professional experience, (preferably with at least 2 years in adult medicine or community health)
Proficient in PC and MS Office skills, particularly Word and Excel
Effective communication skills, written and verbal
Excellent analytical and problem solving skills
Audit and medical chart review experience preferred
Excellent interpersonal skills necessary to interact with all levels of personnel
Working knowledge of hedis measures and ncqa requirements a plus
Have a dependable vehicle every work day and be willing to travel five day a week and stay overnight when appropriate
The candidates will be reviewing medical records to help providers improve their documentation and coding. They will be educating, training and providing assistance in a variety of ways to help providers close gaps in diagnoses and treatment opportunities.
Category:IT  code:new
Job Requirements
MS Office, Ms Excel, Training, Ms Word

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Contact Details
Shruti Shrivastava