Clinical Charge Auditor

Company: Evolent Health
Location: Charleston
Posted on: June 20, 2022

Job Description:

**Your Future Evolves Here**Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Evolenteers make a difference wherever they are, whether it is at a medical center, in the office, or while working from home across 48 states. We empower you to work from where you work best, which makes juggling careers, families, and social lives so much easier. Through our recognition programs, we also highlight employees who live our values, give back to our communities each year, and are champions for bringing their whole selves to work each day. If youre looking for a place where your work can be personally and professionally rewarding, dont just join a company with a mission. Join a mission with a company behind it.**Why Were Worth the Application:**+ We continue to grow year over year.+ Recognized as a leader in driving important diversity, equity, and inclusion (DE) efforts (https://www.evolenthealth.com/diversity) .+ Achieved a 100% score two years in a row on the Human Rights Campaign's Corporate Equality Index making us a best place to work for LGBTQ+ equality.+ Named to Parity.orgs 2020 list of the best companies for women to advance (https://www.evolenthealth.com/about-us/press-releases/8579/evolent-health-named-to-parity.org%E2%80%99s-best-companies-for-women-to-advance-list-2021) .+ Continued to prioritize the employee experience and achieved an 87% overall engagement score on our last employee survey.+ Published an annual DE report (https://dev.evolenthealth.com/sites/default/files-public/Evolent%20Health%202020%20DE%26I%20Annual%20Report.pdf) to share our progress on how were building an equitable workplace.**What Youll Be Doing:****What Youll Be Doing:****The Clinical Charge Auditor for post-pay review is responsible to verify the accuracy claims reimbursement, clinical significance, coding and billing in accordance with the Plans provider agreements and the National Healthcare Billing Audit guidelines through medical record review. The Auditor will collaborate with a variety of business units including Market Operations, Claims, Health and Medical Management (including Medical Directors), Network Management and our external Provider community. The successful candidate must be capable of building and maintaining strong working relationships with key internal and external constituents and working effectively in a matrixed environment.****Responsibilities**** Conduct clinical audits including but not limited to Diagnosis Related Grouper Validation (DRG), medical record billing discrepancies, and prior authorization discrepancies per policies.**** Select claims samples for medical record reviews in accordance with pre-selection criteria, billing trends, and supporting documentation.**** Monitor existing/emerging trends and keep relevant stakeholders informed of risk areas and concerns that may require additional attention or result in additional savings.**** Participates in and/or leads inter-departmental process improvement initiatives. Acting as a subject matter expert with internal and external stakeholders in reference to coding, billing practices, and accuracy of assigned ICD-10 codes and DRGs.**** Identifies compliance risks and financial opportunities based on chart reviews. Performs concurrent review of hospital bills to document unbilled, under billed, and overbilled items/services**** Educate stakeholders on post audit findings and close audits in timely manner using audit program databases that incorporate 3M software.**** Identify potential quality of care issues and service or treatment delays. Make referrals for follow-up as necessary.**** Identify possible fraud and abuse, document billing errors, and benefit cost management and savings opportunities.**** Actively participate in internal/external meetings, training activities and other cost and trend initiatives.**** Identify and pursue new opportunities for cost avoidance savings that contribute to the company's annual financial and service targets.**** Meet deadlines and commitments by tightly managing deliverables, coordinating matrixed inputs, and ensuring all tasks are performed to bring projects to timely closure.**** Represent department on cross functional workgroups and projects as needed.**** Conduct audits remotely using the EVH Payment Integrity platform and electronic medical record documentation.****The Experience Youll Need (Required):**** Active Registered Nurse License.**** Active Certified coder (RHIA, RHIT, CPC, CIC, COC or CCS) required, candidate would need to maintain active certification.**** In-depth knowledge of and ability to interpret ICD-10-CM/PCS, HCPCS/CPT, APR-DRG, MS-DRG codes and DRG grouping systems and Plan benefit designs.**** Ability to travel for onsite audits as needed.**** 3-5 years experience reviewing and/or auditing medical records, working in a health plan, health insurance, or similar environment.**** Strong quantitative, analytical, interpersonal, organizational, project management, problem-solving and communication skills.**** Ability to navigate and manage through difficult, complex conversations with positive outcomes.**** Strong computer skills: proficient in MS Word, Excel, PowerPoint and Outlook, familiarity with Electronic Medical Record systems.**** Ability to work as part of a team with a positive attitude while also able to work independently.****Finishing Touches (Preferred):**** Clinical Documentation Improvement (CDI/CDEO) certification**** Hands-on work with complex medical and billing information preferred****Technical requirements:****Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.****Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status****Technical Requirements:**Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.Evolent Health is committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and federal law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home. Certain jobs require face-to-face interaction with our providers and patients in client facilities or homes. Employees working in such roles will be required to meet our vaccine requirements without exception or exemption.**Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.**Compensation Range: The minimum salary for this position is $, plus benefits. Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts.

Keywords: Evolent Health, Charleston , Clinical Charge Auditor, Accounting, Auditing , Charleston, West Virginia