External Audit Support

Trilogy Health Services, LLC; Louisville (KY); On-site; USD 65,000 - 75,000; Full time

Benefits offered by this job

Weekly pay

401(k) Company Match

Student Loan Repayment

Tuition Reimbursement

Health, Vision, Dental & LifeInsurance

First-time homebuyers’ program

HSA/FSA

Job summary

Trilogy Health Services, LLC in Louisville seeks an External Audit Support professional to review medical necessity for audits and ensure compliant, timely submissions.

You will collaborate with clinical staff, review records, and support denials analysis and education, with an emphasis on HIPAA compliance and accurate documentation.

Qualifications include an Associate Degree and 3-5 years of experience; RN/LPN licenses preferred; therapy licenses optional.

Qualifications

• Associate Degree required.
• 3-5 years of experience in relevant field.
• Active RN or LPN license preferred; therapy licenses may be beneficial.

Responsibilities

• Reviews medical records to assess medical necessity for audits.
• Submits audit requests and appeals timely to payers or external agencies.
• Collaborates with clinical teams to educate on denials trends and documentation gaps.

Education

Associate Degree

Job description

JOIN TEAM TRILOGY

Weekly pay, health and dental after your first month, student loan repayment, a competitive 401(k) match, and more! Make a living while you make a difference at Trilogy Health Services – a senior living provider with the continuous goal of being the Best Healthcare Company in The Midwest.

POSITION OVERVIEW

Job Summary

External Audit Support professional specializing in the submission of medical necessity for post and prepayment audits in all lines of business, plays a crucial role in ensuring compliance with regulatory standards and optimizing reimbursement for services provided. Primary responsibility will be to assess medical records, documentation, and care plans to support the necessity and appropriateness of services rendered in all lines of business. Additionally, will collaborate with interdisciplinary teams to facilitate accurate and timely submission of audit-related documentation, while adhering to industry guidelines and regulations.

Roles and Responsibilities

• Conducts thorough reviews of medical records, including physician orders, nursing notes, therapy documentation, and other pertinent information to assess the medical necessity of services in order to submit our response to audits requested by any payer or external audit agency.
• Ensures timely submission of initial requests and any subsequent appeals.
• Collaborates with internal clinical support teams to relay and educate on any trends in denials.
• Supports tracking and reporting of external audits by vendor and campus to provide the status of Medical Records retrieval, submission/ acceptance of documentation, denial/appeal management, recoupment, and file closure.
• Reviews patient assessments, treatment plans, and progress notes to ensure alignment with established care standards and regulatory requirements.
• Collaborates with healthcare providers, including physicians, nurses, therapists, and other members of the healthcare team, to gather additional information and clarify documentation as needed.
• Utilizes clinical knowledge and expertise to identify potential gaps or discrepancies in documentation that may impact the reimbursement process or compliance with regulatory standards.
• Stays abreast of changes in healthcare regulations, reimbursement policies, and industry best practices related to medical necessity criteria.
• Participates in educational initiatives and training programs to enhance understanding of documentation requirements and promote compliance among staff members.
• Maintains confidentiality and integrity of patient information in accordance with HIPAA regulations and organizational policies.
• Provides support and guidance to staff members involved in the documentation and billing processes, offering education and training as needed to ensure accuracy and consistency.
• Collaborates with internal and external auditors, payers, and regulatory agencies during audits and reviews, serving as a resource and subject matter expert on medical necessity criteria and documentation standards.
• Other duties as assigned.

Qualifications

• Education: Associate Degree
• Experience: 3-5 years

Licenses and Certifications

• Active Registered Nurse (RN) license preferred.
• Active Licensed Practical Nurse (LPN) license with minimum experience of 3-5 years required.
• Active Therapy (OT/PT/SLP) license preferred.

Physical Requirements

Sitting, standing, bending, reaching, stretching, stooping, walking, and moving intermittently during working hours. Must be able to lift at least 50lbs. Must be able to maintain verbal and written communication with co-workers, supervisors, residents, family members, visitors, vendors, and all business associates outside of the health campus.

LOCATION

US-KY-Louisville
Trilogy Health Services
303 N. Hurstbourne Parkway
Louisville
KY

BENEFITS

• Competitive salaries and weekly pay
• 401(k) Company Match
• Mental Health Support Program
• Student Loan Repayment and Tuition Reimbursement
• Health, vision, dental & life insurance kick in on the first of the month after your start date
• First time homebuyers’ program
• HSA/FSA
• And so much more!

EEO STATEMENT

As one of Fortune’s Best Places to Work in Aging Services, a certified Great Place to Work, and one of Glassdoor’s Top 100 Best Companies to Work, Trilogy is proud to be an equal opportunity employer committed to helping you reach your full potential and to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy or any other protected characteristic as outlined by federal, state or local laws.

FOR THIS TYPE OF EMPLOYMENT STATE LAW REQUIRES A CRIMINAL RECORD CHECK AS A CONDITION OF EMPLOYMENT.