National Association of Latino Healthcare Executives · 19 hours ago
Documentation Quality Auditor IV (NCAL residency required)
Oakland, CA
Full-time
Onsite
Senior LevelThe National Association of Latino Healthcare Executives is seeking a Documentation Quality Auditor IV to contribute to coding quality audits and ensure compliance with regulatory requirements. The role involves conducting audits, preparing reports, and enhancing coding integrity by developing new processes and workflows.
Health CareHospitalMedical
Responsibilities
Promotes learning in others by proactively providing and/or developing information, resources, advice, and expertise with coworkers and members; builds relationships with cross-functional/external stakeholders and customers. Listens to, seeks, and addresses performance feedback; proactively provides actionable feedback to others and to managers. Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses; leads by influencing others through technical explanations and examples and provides options and recommendations. Adopts new responsibilities; adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; champions change and helps others adapt to new tasks and processes. Facilitates team collaboration to support a business outcome
Completes work assignments autonomously and supports business-specific projects by applying expertise in subject area and business knowledge to generate creative solutions; encourages team members to adapt to and follow all procedures and policies. Collaborates cross-functionally and/or externally to achieve effective business decisions; provides recommendations and solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results. Supports the development of work plans to meet business priorities and deadlines; identifies resources to accomplish priorities and deadlines. Identifies, speaks up, and capitalizes on improvement opportunities across teams; uses influence to guide others and engages stakeholders to achieve appropriate solutions
Contributes to audit analysis and report writing by: comparing coding and documentation across the enterprise to identify potential risks and remedies independently; conducting trend analyses to identify patterns and variations in coding practices, key compliance drivers, liabilities, and performance indicators (e.g., adherence to standards, incorporation of new regulations), and beginning to coordinate team members to do the same; and preparing written and/or generated audit reports using standardized language detailing all noted opportunities, and providing education as needed
Contributes to coding quality audits by: conducting special projects, audits, reviews, and/or monitoring of assigned lines of business or scope independently to monitor the accuracy and quality of coding and documentation; using processes to assess accuracy and completeness of coded documentation integrity; and following guidelines and procedures to ensure special projects, audits, reviews, and/or monitoring align with state and federal regulatory and reimbursement requirements, current documentation, and coding guidelines, and guiding team members to do the same
Ensures compliance by: following national, state, and KP-specific coding, billing, and documentation guidelines/guidance for KPs leadership, attorneys, physicians, coders, compliance, and billers to help coordinate consistent and accurate implementation and compliance with external regulations; attending national committees; and participating in National Compliance programs to assure maximum utilization of coding resources when conducting special projects, monitoring, reviews, and/or audits
Contributes to enhancing coding integrity by: assisting with the identification of coding/documentation trends and opportunities; leveraging expert knowledge to aid teams in their assigned lines of business or scope in developing, implementing, and monitoring new processes and workflows that support regulatory needs and requirements, organizational goals, and business objectives; and leading the process of communicating up-to-date and accurate regulation, policy, and guideline changes impacting coding and documentation to all impacted employees
Qualification
Required
NCAL residency required
Experience in coding quality audits
Ability to conduct special projects, audits, reviews, and/or monitoring of assigned lines of business or scope
Knowledge of state and federal regulatory and reimbursement requirements
Familiarity with current documentation and coding guidelines
Experience in audit analysis and report writing
Ability to compare coding and documentation across the enterprise
Skills in identifying potential risks and remedies
Experience in preparing written and/or generated audit reports
Ability to enhance coding integrity
Experience in developing, implementing, and monitoring new processes and workflows
Knowledge of national, state, and KP-specific coding, billing, and documentation guidelines
Ability to build relationships with cross-functional/external stakeholders and customers
Experience in providing actionable feedback
Ability to adapt to and learn from change, challenges, and feedback
Experience in facilitating team collaboration
Ability to complete work assignments autonomously
Experience in supporting business-specific projects
Ability to collaborate cross-functionally and/or externally
Skills in solving complex problems
Experience in monitoring progress and results
Ability to identify and capitalize on improvement opportunities
Experience in conducting trend analyses
Ability to prepare written and/or generated audit reports using standardized language
Experience in ensuring compliance with coding, billing, and documentation guidelines
Ability to attend national committees and participate in National Compliance programs
Experience in assisting with the identification of coding/documentation trends and opportunities
Ability to communicate up-to-date and accurate regulation, policy, and guideline changes
Company
National Association of Latino Healthcare Executives
The National Association of Latino Healthcare Executives is a hospital and healthcare organization.
Founded in 2005
11-50 employees
Funding
Current Stage
Early StageLeadership Team
Jackie Sifuentes, MBA, LSSYB
Co-Founder La Mesa Emerging Leaders Mentorship Program for Early Careerists
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