Senior Internal Quality Auditor

The Internal Quality Auditor performs coding and/or clinical documentation integrity (CDI) audits to ensure compliance with Federal and State Regulations. The reviewer will have the primary responsibility of being an expert resource to the internal quality review team, coders/CDI specialists and coding/CDI managers.

Job Tasks: 

• The reviewer will identify cases coded incorrectly and provide feedback and supporting documentation for changes to the coder/CDI specialist.
• Utilize only recognized official coding resources when performing reviews.
• Perform coding/CDI reviews, both concurrent, prebill and retrospective according to auditing schedule.
• Audits for appropriate clinical documentation to support diagnosis capture and to ensure the level of service rendered to all patients is recorded.
• Serves as an expert resource in reviewing all medical records in support of consistent documentation for all payer types (i.e. CMS, Medicare-Advantage, etc.) to ensure complete and accurate diagnosis capture, coding and queries.
• Provides recommendations for improvement and suggestions for better quality and compliance.
• Maintain productivity based on type of cases reviewed and quality standards.
• Complete audits within established timeframes.
• Completion and follow through of all processes entailed in reviews and client obligations utilizing reviewer’s own initiative.
• Reviewer to adhere to ‘Standard Terminology for Quality Reviewer Recommendations’ Policy
• Other duties as assigned
• Prepare and maintain a productivity log

Education & Years of Experience

• Bachelor's Degree plus 2-5 years of work experience OR High School Diploma/GED plus 6-9 years of work experience

Certifications

• Certified Coding Specialist (CCS) (Preferred)
• Registered Health Information Technician (RHIT) (Preferred)
• Certified Documentation Improvement Practitioner (CDIP) (Preferred)

Additional Experience

• Experience in medical coding or auditing
• Experience with various Encoder, Computer Assisted Coding, and Electronic Health Records software applications
• Experience in healthcare billing, accounting, or equivalent

• Work is performed in an office/home office environment.
• Team Members must have the ability to operate standard office equipment and keyboards.

AMN Healthcare will provide reasonable accommodations to qualified individuals with disabilities to enable them to perform the essential functions of the job.

● Respect ● Passion ● Continuous Improvement ● Trust ● Customer Focus ● Innovation

At AMN we embrace the ways we are similar and different; respecting all voices and ensuring everyone has the opportunity to contribute to our collective success. We acknowledge our shared responsibility to foster a welcoming environment where everyone feels recognized and valued. We cast a wide net to recruit and retain competitive talent and build healthcare workforces supportive of the communities we serve. We believe in the power of compassion and collaboration to build healthy communities where access to quality care is available to all. Equal opportunity employer as to all protected groups, including protected veterans and individuals with disabilities.

At AMN we recognize that in-person connections have value and promote collaboration. You will be expected to come into an AMN Healthcare office at a frequency dependent on the work arrangement for your role.

Final pay rate is dependent on experience, training, education, and location.