Lead Health Information Management Audit Specialist
Core
Lead Health Information Management Audit Specialist responsible for third-party audits of medical records for reimbursement, regulatory compliance, quality, and appropriateness at Beth Israel Lahey Health.
Role type
Senior IC Health Information Management Audit Specialist
Builds
Healthcare claims audit processes and compliance reporting
Domain
Healthcare / Health Information Management / Medical Billing
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Medical terminology, anatomy and physiology, general coding guidelines for reimbursement, EHR system usage, Microsoft Word and Excel, project management, analytical problem-solving
Preferred skills
Clinical background (RN or LPN), HIM degree, Coding certification
Technologies
Epic, Cobius Health, ECMS, Documentum, Microsoft Excel, PowerPoint
Responsibilities
Prepare and report status and outcomes of audit and compliance components; oversee adherence to audit standards; lead and assist with audits for CMS, CERT, RACs, ADR, Quality, Medical Necessity, and DRG Insurers; research and analyze CMS requirements for billing; act as system administrator for audit tracking system; train external and internal auditors on systems; formulate appeals with physicians and billing personnel; respond to third-party payor requests; coordinate other audits and projects.
Seniority
Senior, hands-on IC with mentorship responsibilities
