ICD-10 Chart Auditor: Drive Care Gaps & Quality

JPS Health Network; Fort Worth (TX); On-site; USD 52,000 - 78,000; Full time

Job summary

The Chart Auditor will perform clinical reviews to determine the accuracy of ICD-10 codes on forms from payors, conduct outreach for the Transition of Care program, validate ED high utilization attribution, and review gap in care reports to address patient health risks. This role requires accessing proprietary systems to audit medical records and document findings for clinic providers.

Requirements include LVN/RN licensure and 2+ years of clinical experience; Bachelor’s in Nursing is preferred.

Qualifications

• Relevant clinical experience in chart reviews or payor reviews.
• Experience auditing medical records and ICD-10 coding guidance.

Responsibilities

• Review medical records and forms to verify ICD-10 coding accuracy.
• Document decisions and rationale for review findings.
• Pend orders to address outstanding patient care gaps.
• Perform outreach for patients discharged from inpatient stays.
• Assist management with training new Chart Auditor.
• Maintain knowledge of clinical criteria to uphold licensure.
• Attend trainings and meetings to improve clinical policies and procedures.
• Cross-train to review multiple payor types and requirements.
• Suggest and test process improvements and audit concepts.
• Review payor gap in care reports to validate medication adherence.

Skills

Clinical experience

Medical records auditing

Education

RN or LVN licensure

Job description

The Chart Auditor will perform clinical reviews to determine the accuracy of ICD-10 codes on forms from payors, conduct outreach for the Transition of Care program, validate ED high utilization attribution, and review gap in care reports to address patient health risks. This role requires accessing proprietary systems to audit medical records and document findings for clinic providers.

Requirements include LVN/RN licensure and 2+ years of clinical experience; Bachelor’s in Nursing is preferred.