Job Description

University of Utah Job Description

Job Summary

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.

Qualifications

• Three to five years of clinical experience in a patient care capacity is required.
• Patient care experience may be substituted with equivalent years of experience in medical necessity review.
• Current medical licensure through DOPL (or equivalent state agency) such as, but not limited to: RN, BSN, NP, PA, etc preferred.
• Must be proficient with word processing, spreadsheet, and related computer applications and have exemplary human relations and effective communication skills.
• Requires a sound knowledge of clinical practice and exceptional critical thinking and leadership abilities.
• Department may require coding certification (CPC, ACS, CCS-P/H, RHIA, or RHIT).”

Applicants must demonstrate the potential ability to perform the essential functions of the job as outlined in the position description.

Disclaimer

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.

Essential Functions

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.

Comments

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.