Registered Nurse

1 month ago


Pomona, United States Compunnel Full time
Description

Summary of Major Function:
The Clinical Documentation and Coding Integrity Quality Auditor performs clinical documentation validation reviews.

Performs quantitative and qualitative reviews and analysis of the clinical health records and physician queries both concurrently and retrospectively to ensure documentation is accurate, consistent and complete.

Quality Auditor identifies educational opportunities, including discrepancies in clinical indicators and diagnostic statements which impact DRG assignment, severity of illness, risk of mortality and resource utilization.

Quality Auditor is also involved in the clinical denial/appeal process for DRG challenges and clinical validations of both external and internal claims.

The Quality Auditor utilizes analysis of data, dashboards, and audits to assist in identifying gaps, root causes and solutions for clinical documentation specialists and physician leadership.

The Quality Auditor acts as a subject matter expert and resource for the Clinical Documentation Specialists and assumes the role of CDS as demands for services requires. May perform other duties as assigned.
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