Job Summary: Under the direction of the Northern Light Health Vice President/Chief Compliance and Internal Audit Officer and the Northern Light Health Director of Internal Audit, the Medical Auditor will plan and conduct scheduled and ad hoc clinical and other appropriate internal audits of Northern Light Health Members as assigned. Based on third party and internal audit results and on any other resources appropriate to the issue at hand, the Medical Auditor will plan and provide education to improve Member processes and results. The Medical Auditor will provide written and oral reports as necessary to keep Northern Light Health leadership informed of the status of audit projects. The Medical Auditor will monitor and report on audit client compliance with audit recommendations. The Medical Auditor also will function as a clinical expert to the Northern Light Health Compliance and Internal Audit teams. In carrying out these activities the auditor shall have full, free and unrestricted access to all functions, records, property and personnel.
Education required: Bachelor's Degree, preferably in clinical discipline, with knowledge of coding procedures.
Experience required: Three to five years clinical experience, preferably as a registered nurse in a clinical setting. Prior auditing experience is preferred. Understands ancillary department patient care and how patient care operations are supported by pharmacy, radiology, laboratory, pathology, and rehab services. Understands charging procedures and information systems. Significant teaching or educational presentation experience required. Should possess or obtain understanding of medical office processes and procedures. Thorough knowledge of CPT and ICD-10 coding preferred.
Other skills required: CPC preferred. Must be able to handle deadlines and handle multiple projects. Must be able to work independently. Accuracy and attention to detail required. The Medical Auditor must have knowledge of Medicare and other insurance regulations, policies and functions; be knowledgeable of healthcare revenue cycle practices and methods, as well as internal policies and procedures of Northern Light Health Members; and be detail-oriented and timely in completing work assignments. The Medical Auditor should be strong in analytics, and have well-developed written and verbal communication skills. The Medical Auditor must have a high degree of integrity and professionalism and possess the interpersonal skills necessary to develop and foster strong relationships with Patient Account Services, nursing and ancillary department leaders, and their staffs, among others.
Physical Requirements/Working Environment: Normal office work environment. Some travel required.
Equal Opportunity Employment
We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status.