EMG Referral Auditor - Ambulatory Patient Quality - Remote/Onsite - Full-Time

Job Summary:

The Erlanger Medical Group (EMG) Referral Auditor is responsible for maintaining ongoing tracking of all EMG primary care offices' outgoing referrals. This tracking must be done using the IT database and an overdue timeline is set according to the National Committee for Quality Assurance (NCQA) processes. EMG Referral Auditor will be responsible for identifying errors within referral, in quality metrics and will report these back to the IT department.

He/she will maintain excel spread sheets for reporting to upper management productivity and identify offices where extra help/training is needed. Will be actively involved in: improving continuity of care; facilitating effective communication among providers; and retrieving records which serve as a basis for reimbursement and are a critical component in the defense of malpractice lawsuits.

The EMG referral auditor will ensure complete and accurate registration has been obtained within the offices, including patient demographics, current insurance information, and specialist name and address for Summary of Care. The Summary of Care is required to be completed for obtaining Erlanger's 'Promoting Interoperability' and Year-End quality scoring.

The EMG referral auditor is a system navigator for any process questions and serves as a direct contact for the referring provider and staff for all missed appointments by patients. If a patient misses an appointment the referral auditor will notify the provider and nurse while sending a letter to the patient and originating referral auditor to reschedule the appointment. Mailing of all departmental letters to patients and ensuring the mailing charges are applied to the correct cost center are part of the daily responsibilities.

The EMG referral auditor will ensure all appropriate and complete exam notes, labs, visit summaries, test both diagnostic and screening are routed properly to the referring provider for signature and documentation of acknowledgement of specialist plan and recommendation. In addition to obtaining the notes, the EMG referral auditor will ensure all diagnostic testing, labs, and imaging are scanned into the proper section within the permanent record to close the GAP in CARE.

Identifying improper scanning, notifying the practice manager, travelling to the practices, and teaching proper scanning and documentation of referrals and results with new employees or employees needing to be re-trained. Closing the gap in care while using this proper scanning technique is required for reporting to payers, and year-end quality reporting for Medicare and affects the total Merit-Based Incentive Payment System (MIPS) scoring for the entire health system.

The EMG referral auditor will also reach out to various Emergency rooms, community organizations, hospitals and inpatient facilities when a patient has been hospitalized per the direction of a Transition of Care nurse and ensure records are ready for the hospital follow-up visit. He/she must have the ability to work extra projects during designated times for reporting periods within our Accountable Care Organization.

This position is involved in a team-based approach to care. Team members are trained to meet the highest level of function for their role as per the State of Tennessee/Georgia guidelines.

Is trained and assigned (as per their role and responsibilities) to coordinate care for patients and is trained and assigned to support patients/families/caregivers in self-management, self-efficacy and behavior change. Is trained and assigned (as per their role and responsibilities) to manage the practices' patient population. Participates in the practice's quality improvement process and performance evaluation.

Education:

Required:

Associate's Degree in Computer Science or data analysis related field or equivalent work experience in healthcare related field.

Preferred:

Associates Degree in Business Administration, or Medical office assistant, Physician Coder or equivalent

Experience:

Required:

Must have 3 years' work experience with no current disciplinary actions within the past year. Must have experience working in an electronic medical record.

Preferred:

Position Requirement(s): License/Certification/Registration

Required:

Certified Coder or completed Coder Certification within 1 year of hire

Preferred:

Department Position Summary:

The EMG Referral Auditor is a vital part of our team. Must have strong Medical terminology, and moderate knowledge of CPT and ICD10 codes, and insurance coding and billing.

Must have the ability to read, write and solve mathematical problems including fractions, decimals and percentages. Strong computer skills with ability to create and maintain excel spread sheets. Excellent customer service skills and interpersonal communication and telephone etiquette are required.

Exhibit comprehension of registration and physician order processes. Ability to interpret clinical documentation from physician office to ensure all records are complete. Computer, fax machine, copier, multiline telephone. Demonstrate ability to multitask and manage high volumes, individual is a self-starter and demonstrated ability to prioritize work in a sometimes stressful environment.

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