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Document Integrity Specialist - Phoenix Biltmore

Revenue Cycle Management

  • Posted: 27 April 2021
  • Full-time
  • Phoenix, AZ, USA

At American Vision Partners (AVP), we’re bringing the best together. Our company was created with the affiliation of Barnet Dulaney Perkins Eye Center, Southwestern Eye Center, and the M&M Eye Institute. Today we’re one of the nation’s largest and most comprehensive ophthalmology practices with more than 45 eye care centers in Arizona and New Mexico - including 24 ambulatory surgical centers. At AVP we are committed to best in class patient care, being a pioneer in research and technology and most importantly, rewarding and recognizing our employees!

Document Integrity Specialist
American Vision Partners - Phoenix Biltmore

This position is responsible for ensuring that all appropriate complex payer audit requests for documentation are completed within the defined timelines including full review prior to submission. This position will ensure the integrity of the Electronic Health Record (EHR) by monitoring, measuring, and reporting on documentation created by healthcare providers. Documentation created within the EHR is reviewed for content and context. The Specialist compiles feedback for healthcare providers on critical and major errors that have the potential to impact document integrity and/or patient care, thereby eliminating repetition of errors. The auditor may request clarification from the clinician.  

Responsibilities: 

  • Responsible for reviewing and responding to CMS documentation requests including but not limited to: Additional Documentation Requests (ADR), Zone Program Integrity Contractors (ZPIC), Supplemental Medical Review Contractor (SMRC), Comprehensive Error Rate Testing (CERT) and Recovery Audits (RAC).
  • Coordinates on site and off site HEDIS audits with third party payors ensuring that appropriate documentation and medical record requests are provided within required timelines.
  • Responsible for reviewing and gathering appropriate documentation for payor requested Risk Adjustment Audits. Coordinates on site chart pulls as appropriate.
  • Responsible for conducting retrospective, prospective and concurrent reviews for documentation improvement opportunities.
  • Performs quality review and analysis of patient information documented by providers (both hardcopy and electronic) for provider/documentation deficiencies.
  • Actively communicates with providers at all levels, to clarify information and to communicate documentation requirements for appropriate diagnoses based on severity of illness and risk of mortality.
  • Provides education to providers related to feedback received from Risk Adjustment Audits.
  • Review denial trends for documentation or charging issue opportunities.
  • Interact with clinical departments to obtain additional information needed to properly bill account based on medical record.
  • Analyzes business processes to identify possible inefficiencies and makes recommendations to improve procedures, prevent future cash losses and to optimize reimbursement.
  • Supports Management by providing information, locating data sources and collecting data under tight time constraints.
  • Assist with special projects as assigned.
  • Identifies and communicates trends and/or potential issues to management team.
  • Prioritize work to maximize turn-around time.
  • Performs all other assigned duties.
  • Conducts self in accordance with the company’s standard values and policies.
  • Participates in a variety of educational programs, corporate and professional, to maintain current skill and competency levels. Documentation Integrity Specialists must attend webinars, classes, lectures, internal meetings, etc. to maintain current knowledge regarding CMS reimbursement, commercial payer contracts, charging policies and changes that impact revenue, such as CPT and coding changes.

Qualifications:

  • High School Diploma or GED required
  • Strong background and experience in Revenue Cycle.
  • Active knowledge of CMS guidelines, contracted insurance guidelines and coding policies.
  • Demonstrated computer literacy
  • Well-organized with attention to detail
  • Ability to read and understand oral and written instructions
  • Excellent math skills
  • Ability to establish and maintain effective working relationship with team members, clinic staff, payers and patients.
  • Professional customer service skills.
  • Have a desire and dedication to work with self-discipline.
  • Maintains the strictest confidentiality: adheres to all HIPAA guidelines and regulations.
  • 5 years medical billing experience
  • Ophthalmology background desired
  • Must possess a certification as a RHIA/RHIT/CCS/CCS-P/CPC/CIC/COC

Benefits & Perks:

Your health, happiness and your future matters! At AVP, we offer everything from medical and dental to significant eye care discounts, continuing education, 401(k), 9 paid holidays plus PTO, flexible work hours and much more!

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.