Robert Half - Internal Auditor
Robert Half San Antonio
We are seeking an Internal Auditor to join our team in San Antonio, Texas. This role is pivotal in the health care industry, focusing on the auditing and validation of coding and billing practices, electronic medical record maintenance, and the use of E Clinical Works software.
Responsibilities- Conduct prospective and retrospective chart reviews and audits, ensuring accurate and efficient coding practices.
- Assess CMS-HCC category coding, contributing to the improvement of RAF score goals and revenue maximization.
- Collaborate with the management team in selecting appropriate records for Health Plan chart reviews or CMS RADV audits.
- Utilize tracking and management tools for medical record review projects, maintaining productivity and quality metrics as per QA policy.
- Adhere to state and federal rules, regulations, and ICD-CM coding guidelines, demonstrating an understanding of Medicare HCC coding knowledge.
- Participate in monthly coding/documentation webinars, staying updated with industry trends and changes.
- Comply with HIPAA protocol and other privacy and security measures, ensuring the confidentiality and security of patient information.
- Assist in assessing coding opportunities and actively identify areas that require provider education.
- Display proficiency in ICD-10-CM, CPT, HCPCS coding, medical terminology, and pharmacology.
- Exhibit strong analytical, organizational, and problem-solving skills, capable of working independently and prioritizing tasks to meet deadlines. • Must have a minimum of 3 years of experience in internal auditing
- Proficient in Accounting Software Systems
- Experience with Audit Program is essential
- Knowledge of Business Systems is required
- Familiarity with Accounting Functions
- Ability to develop and implement Audit Plans
- Must have experience in Data Validation
- Knowledge of ICD-10 coding system
- Experience with Medicare Advantage plans
- Proficiency in Medical Coding
- Familiarity with CPT Codes
- Experience with HCPCS Coding
- Must be proficient in using ECW (eClinicalWorks) software
- Bachelor's degree in Accounting, Finance, or a related field is required
- Certified Internal Auditor (CIA) or Certified Public Accountant (CPA) designation is preferred
- Excellent written and verbal communication skills
- Strong analytical and problem-solving skills
- Ability to work independently and as a part of a team
- Must have strong ethical standards and high levels of integrity
- Ability to handle sensitive and confidential information with discretion
- Strong attention to detail and excellent organizational skills
- Ability to meet deadlines and manage multiple tasks
- Knowledge of local, state, and federal regulatory requirements related to the role is desirable
- Must have a proactive approach to identify risks, evaluate their implications, and recommend improvements.
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