• Job Description

  Req#: 302549

  At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day.

  We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One.

  Job Title

  Medical Chart Auditor (Hybrid)

  Location

  Independence

  Facility

  Business Operations Center

  Department

  Internal Audit-Finance

  Job Code

  T99503

  Shift

  Days

  Schedule

  7:00am-4:00pm/8:00am-5:00pm

  Job Summary

  Position is hybrid, 3 days remote and 2 days onsite, Wednesday and Thursday, in Independence.
  
  Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as the No. 4 hospital in the nation, according to the U.S. News & World Report. At Cleveland Clinic, you will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.
  
  Under the direction of the Sr, Director of Operations, the Medical Chart Auditor will:
  - Perform quality chart audits on all medical services requested by third party payers, audit firms, Institutes or others.
  - Prepare monthly reports of results from audit requests.
  - Inform Internal Audit or Corporate Compliance when appropriate.
  - Participate in audits conducted by operations, finance, information technology or research.
  
  The ideal future caregiver is someone who:
  - Has strong experience in healthcare Clinical Operations/Internal Audit, especially the clinical side.
  - Works well with facts and doesn’t make assumptions.
  - Is comfortable reaching out to departments and personnel to get answers about charges and procedures.
  - Demonstrates a strong work ethic.
  
  This position will work a hybrid schedule of three days working remotely and two days, Wednesday and Thursday, in-person. Everyone on this team brings a different skillset and works well independently allowing for schedule flexibility and cohesion.
  
  Cleveland Clinic provides what matters most: career growth, delivering world-class care to our patients, continuous learning, exceptional benefits and working for an organization that offers many long-term career paths. Join us and experience a culture where opportunities to advance and the support to get there go hand-in-hand.

  Job Details

  Responsibilities:

  • Performs quality audits on all medical services requested by outside 3rd party payers or audit firms representing them.
  • Provides feedback to Reimbursement Managers, Institutes and Clinical areas resolving any issues uncovered during the reviews.
  • Prepares reports, results of audits or requests.
  • Negotiates settlement of on-site reviews of Cleveland Clinic patient bills with audit representatives of 3rd party payers.
  • Develops and documents audit findings, including recommendations for improving controls and reducing or recovering costs.
  • Performs concurrent reviews of Medicare cases with cost outlier status.
  • Other duties as assigned.

  Education:

  • Bachelor's/Associate's Degree in Business Administration. May substitute years of Healthcare/Hospital experience.

  Certifications:

  • Registered Nurse (RN), Licensed Practical Nurse (LPN) or Certified Professional Coder (CPC).
  • Coding credential required - Certified Medical Audit Specialist (CMAS) ,Certified Professional Coder Hospital (CPCH), Certified Coding Specialist (CCS), Certified Professional Coder (CPC) or Registered Health Information Technician (RHIT).

  Complexity of Work:

  • Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.
  • Must be able to work in a stressful environment and take appropriate action.

  Work Experience:

  • A Minimum of four years of hospital experience with medical chart reviews, CPT/ICD9 coding and billing is preferred.
  • Experience with Medicaid and Managed Care reimbursement payment policies.
  • Knowledge of federal, JCAHO, state and local regulations and standards.
  • Working knowledge of information systems, effective personal computer skills, and excellent oral and written communication skills are highly desirable.
  • Appropriate experience in generally accepted auditing principles and practices as they may apply to billing audits.

  Physical Requirements:

  • Manual dexterity to operate office equipment.
  • Ability to lift and transport up to 15 pounds.
  • Requires extended periods of standing, walking and sitting.
  • Normal or corrected vision and hearing to normal range.

  Personal Protective Equipment:

  • Follows standard precautions using personal protective equipment as required.

  The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. All offers of employment are follwed by testing for controlled substances and nicotine. All new caregivers must clear a nicotine test within their 90-day new hire period. Candidates for employment who are impacted by Cleveland Clinic Health System's Smoking Policy will be permitted to reapply for open positions after one year.

  Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.

  Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility.

  Please review the Equal Employment Opportunity poster .

  Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Individuals with Disabilities

• About the company

  PUSHING THE BOUNDARIES OF PERFORMANCE Through the Power of Every One, Cleveland Clinic is ranked as the nation’s No. 2 healthcare system by U.S. News & World Report – the best care for our patients starts with us.

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