Professional Documentation Improvement Auditor

Overview

Ardent Health is a leading provider of healthcare in communities across the country. With a focus on consumer-friendly processes and investments in innovative services and technologies, Ardent is passionate about making healthcare better and easier to access. We are driven by our purpose of caring for people: our patients, our communities and one another.

Located in Brentwood, Tennessee, Ardent has earned a reputation as one of the industry’s strongest and most innovative healthcare systems. Our facilities and clinics are consistently recognized among healthcare’s best employers. We recognize each hospital and clinic is as unique as the community it serves. We strive to maintain strong community ties through advisory boards, contributions, charitable care, education and outreach.

Ardent includes

• 30 hospitals
• 280 sites of care
• 4,281 beds
• 24,000+ team members
• 8,200+ nurses
• 1,800+ aligned providers
• 5.8M annual provider encounters
• 421 medical residents

Ardent makes considerable investments in people, technology, facilities, and communities, producing high quality care and extraordinary results. From newly constructed facilities and expanded services, to lifesaving technology and outstanding opportunities for employees, Ardent is committed to providing its hospitals and clinics the tools needed to succeed.

We believe it is this mix of corporate support and local autonomy that equips our teams for success.

POSITION SUMMARY

The Professional Documentation Improvement Auditor specializes in reviewing and analyzing medical records, claims and workflow processes to ensure accuracy, completeness, and compliance with regulatory requirements. The primary goal is to improve the quality of clinical documentation, which plays a crucial role in patient care, compliance, billing, coding, and reimbursement processes.

Responsibilities

• Using audit tools, authoritative references, CMS and CPT guidelines, bell curves, etc. to analyze for trends, audit providers and coders, and provide education/feedback individually or in a group setting.
• Adhering to policies, procedures and regulations to ensure compliance.
• Audits provider services using auditing tools such as EncoderPro and MD Audit.
• Adheres to provider auditing schedules and audit production standards set by Physician Compliance and Audit Services Director or the Physician Audit Managers.
• Maintains provider scoring results.
• Provides standard documentation on education feedback to providers in a timely manner.

Qualifications

Job Requirements

• Associate’s Degree
• Additional years of experience may substitute for the required education on a year-for-year basis
• 3+ years auditing experience or 5 years of coding E&M levels of service (multi-specialty, including office visits, preventive services, surgical procedures and hospital inpatient and observation services.
• CPC (Certified Professional Coder) or equivalent certification
• Revenue Cycle experience, preferred.
• Auditing certification (e.g. CPMA -Certified Professional Medical Auditor), strongly preferred.
• Additional specialty specific certifications (e.g. CCC – Certified Cardiology Coder, COBGC – Certified OB/GYN Coder), strongly preferred
• E&M /Procedure/Surgery Auditing/Critical Care/Specialty Specific/Skewed Productivity Curves
• Application and validation of ICD-10 diagnosis codes based on coding guidelines

Preferred Job Requirements

• Revenue Cycle experience Additional specialty specific certifications (e.g. CCC – Certified Cardiology Coder, COBGC – Certified OB/GYN Coder)
• Auditing certification (e.g. CPMA-Certified Professional Medical Auditor)
• Using audit tools, authoritative references, CMS and CPT guidelines, bell curves, etc. to analyze for trends, audit providers and coders, and provide education/feedback individually or in a group setting.
• Adhering to policies, procedures and regulations to ensure compliance.
• Audits provider services using auditing tools such as EncoderPro and MD Audit.
• Adheres to provider auditing schedules and audit production standards set by Physician Compliance and Audit Services Director or the Physician Audit Managers.
• Maintains provider scoring results.
• Provides standard documentation on education feedback to providers in a timely manner.

Job Requirements

• Associate's Degree
• Additional years of experience may substitute for the required education on a year-for-year basis
• 3+ years auditing experience or 5 years of coding E&M levels of service (multi-specialty, including office visits, preventive services, surgical procedures and hospital inpatient and observation services.
• CPC (Certified Professional Coder) or equivalent certification
• Revenue Cycle experience, preferred.
• Auditing certification (e.g. CPMA -Certified Professional Medical Auditor), strongly preferred.
• Additional specialty specific certifications (e.g. CCC - Certified Cardiology Coder, COBGC - Certified OB/GYN Coder), strongly preferred
• E&M /Procedure/Surgery Auditing/Critical Care/Specialty Specific/Skewed Productivity Curves
• Application and validation of ICD-10 diagnosis codes based on coding guidelines

Preferred Job Requirements

• Revenue Cycle experience Additional specialty specific certifications (e.g. CCC - Certified Cardiology Coder, COBGC - Certified OB/GYN Coder)
• Auditing certification (e.g. CPMA-Certified Professional Medical Auditor)