Clinical Audit Analyst

Commonspirit-Health; Colorado Springs (CO); On-site; USD 70,000 - 95,000; Full time

Job summary

CommonSpirit-Health in Colorado Springs is seeking a Clinical Audit Analyst to perform comprehensive audits across the care continuum, ensuring accuracy and strict adherence to policies and regulations. You will assess the full care process from physician orders and registration to charting, charging, billing, and reimbursement.

Collaborating with revenue integrity advisors and hospital departments, you will analyze findings, identify root causes, and provide education to drive process

Qualifications

• Strong analytical and auditing skills required.
• Meticulous attention to detail in reviewing data and documentation.
• Knowledge of healthcare regulations and compliance practices.
• Ability to collaborate with multiple departments to ensure compliance and drive improvements.

Responsibilities

• Perform concurrent, internal, defensive, and patient requested audits.
• Collect, analyze, synthesize, and prepare data for senior management and other stakeholders.
• Apply broad knowledge of medical terminology, documentation, and treatment protocols to audit findings.
• Maintain knowledge of CPT/HCPC codes and modifiers and their use.
• Recommend improvements for charging and documentation deficiencies based on trend analysis.
• Stay informed on federal and state regulations and advise management of potential violations.

Skills

Analytical skills

Auditing

Regulatory knowledge

Collaboration

Education

Bachelor's Degree or BSN

Associate's Degree

High School Diploma/G.E.D.

Job description

Job Summary and Responsibilities

As our Clinical Audit Analyst, you will perform clinical and operational audits to verify the accuracy of information and ensure meticulous compliance with established policies, practices, and regulations.
Every day you will conduct quality reviews of the entire care process, from physician order and registration to chart documentation, charging, billing, and reimbursement. You will also collaborate with revenue integrity advisors for root cause analysis and provide education to departments based on audit findings.
To be successful in this role, you will possess strong analytical and auditing skills, meticulous attention to detail in reviewing clinical and operational data, a deep understanding of healthcare regulations, and the ability to effectively collaborate with various departments to ensure compliance and drive process improvements.

• Perform concurrent, internal, defensive, and patient requested audits.
• Accurately collects, analyzes, synthesizes, and prepares data and conducts work in a timely manner for use by senior management, service lines, medical staff, and hospital departments.
• Possess and apply broad knowledge of medical field and hospital processes to include, but not limited to medical terminology, medical record documentation/contents, injury/disease processes, and treatment protocol & practices.
• Maintain working knowledge of CPT/HCPC codes and modifiers and appropriate use.
• Recommends improvements for charging and documentation deficiencies, based on analysis and evaluation of revenue/department error trends.
• Maintain working knowledge of federal and state government regulations and advise management of any possible violation so appropriate action can be taken.

Job Requirements

Required

• High School Diploma/G.E.D.
• Associate's Degree
• Five (5) years direct patient care in a hospital setting

Preferred

• Bachelor's Degree or BSN
• RN experience; although technical skills and medical experience may substitute
• State of employment RN license
• Operating Room experience

Where You'll Work

Penrose - St. Francis Health Services is a full-service, 712-bed acute care provider in Colorado Springs comprising Penrose Hospital, St. Francis Hospital and St. Francis Hospital - Interquest. Penrose Hospital serves as the anchor hospital of Penrose-St. Francis Health Services with 300-licensed beds and the ability to provide tertiary (high tech) medical-surgical services with an emphasis on elective and outpatient care. Established in 1890, Penrose Hospital has grown to become a major health treatment and referral center, specializing in cancer care, cardiac care, emergency trauma care and physical rehabilitation. It's an incredible time to join us as we are a proud Magnet Hospital with designation from the American Nurses Credentialing Center (ANCC) for superior quality in nursing care. With more than 300 days of annual sunshine, mild winters and easy-to-access recreational areas like Pikes Peak, Garden of the Gods and some of Colorado's top destination resorts, you will enjoy an incredible lifestyle while having the career you've always wanted.