University of Utah Job Description
Responsible for conducting audits of medical necessity of services provided through a review of clinical practice standards and provided documentation. Ensures patient billing practices conform to government reimbursement guidelines by monitoring current practices, managing and documenting audit processes, developing and implementing systems to track compliance activities and providing compliance education.
Applicants must demonstrate the potential ability to perform the essential functions of the job as outlined in the position description.
This job description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to the job.
1. Reviews documentation for medical necessity. 2. Teams with providers and staff to assist departments in implementing compliance practices and monitors and coordinates those activities with the departments.3. Oversees, coordinates and conducts audits on documentation, abstraction and coding to ensure compliance with University, state and federal guidelines.4. Responsible for assisting the University in preparation for regulatory audits by developing, monitoring and updating quality controls and recommending actions to maintain compliance.5. Analyzes and documents audit processes. 6. Monitors required documentation related to audit processes.7. Recommends enhancements to operating policies and procedures for compliance review.8. Maintains current knowledge regarding federal and state guidance, organizational needs and payer regulations. 9. Serves as an expert resource in compliance issue resolution.
Work Environment and Level of Frequency typically required
Nearly Continuously: Office environment.
Physical Requirements and Level of Frequency that may be required
Nearly Continuously: Sitting, hearing, listening, talking.
Often: Repetitive hand motion (such as typing), walking.
Seldom: Bending, reaching overhead.
250 East 200 South, Suite 125,
Salt Lake City, Utah 84111
Phone: 801.581.2169 Email: AskHR@utah.edu
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