Documentation Quality Auditor III

Job Summary:

Contributes to coding quality audits by conducting special projects, audits, reviews, and/or monitoring of assigned lines of business or scope under the guidance of senior employees to monitor the accuracy and quality of coding and documentation. Contributes to audit analysis and report writing by comparing coding and documentation across the enterprise to identify potential risks and remedies, with minimal day-to-day supervision, and following procedures to prepare audit reports detailing all noted opportunities. Contributes to enhancing coding integrity by aiding teams in their assigned lines of business or scope in implementing and monitoring new processes and workflows that support regulatory needs and requirements, organizational goals, and business objectives. 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 assist with consistent and accurate implementation and compliance with external regulations.

Essential Responsibilities:

• Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members. Listens to, seeks, and addresses performance feedback; provides mentoring to team members. Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes. Supports and responds to the needs of others to support a business outcome.
• Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives. Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports, identifies, and monitors priorities, deadlines, and expectations. Identifies, speaks up, and implements ways to address improvement opportunities for team.
• Contributes to audit analysis and report writing by: comparing coding and documentation across the enterprise to identify potential risks and remedies, with minimal day-to-day supervision; 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 following standardized procedures to prepare written and/or generated audit reports using standardized language detailing all noted opportunities.
• Contributes to coding quality audits by: conducting special projects, audits, reviews, and/or monitoring of assigned lines of business or scope under the guidance of senior employees to monitor the accuracy and quality of coding and documentation; using processes to assess accuracy and completeness of coded documentation integrity, with guidance; 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.
• 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 assist with consistent and accurate implementation and compliance with external regulations; coordinating with others to attend national committees; and attending 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: supporting the identification of coding/documentation trends and opportunities; leveraging comprehensive knowledge to aid teams in their assigned lines of business or scope in implementing and monitoring new processes and workflows that support regulatory needs and requirements, organizational goals, and business objectives; and communicating up-to-date and accurate regulation, policy, and guideline changes impacting coding and documentation to all impacted employees.