Senior Clinical Auditor

CAROUSEL_PARAGRAPH

• Birmingham, Alabama
• Surgical Care Affiliates
• Medical & Clinical Ops
• Regular
• Full-time
• 1
• USD $85,000.00/Yr.
• USD $95,000.00/Yr.
• 39797

Job Description

At SCA Health, we believe health care is about people - the patients we serve, the physicians we support and the teammates who push us forward. Behind every successful facility, procedure or innovation is a team of 15,000+ professionals working together, learning from each other and living out the mission, vision and values that define our organization.

As part of Optum, SCA Health is redefining specialty care by developing more accessible, patient-centered practice solutions for a network of more than 370 ambulatory surgical centers, over 400 specialty physician practice clinics and numerous labs and surgical hospitals. Our work spans a broad spectrum of services, all designed to support physicians, health systems and employers in delivering efficient, value-based care to patients without compromising quality or autonomy.

What sets SCA Health apart isn't just what we do, it's how we do it. Each decision we make is rooted in seven core values:

• Clinical quality
• Integrity
• Service excellence
• Teamwork
• Accountability
• Continuous improvement
• Inclusion

Our values aren't empty words - they inform our attitudes, actions and culture. At SCA Health, your work directly impacts patients, physicians and communities. Here, you'll find opportunities to build your career alongside a team that values your expertise, invests in your success, and shares a common mission to care for patients, serve physicians and improve health care in America.

At SCA Health, we offer a comprehensive benefits package to support your health, well-being, and financial future. Our offerings include medical, dental, and vision coverage, 401k plan with company match, paid time off, life and disability insurance, and more. Click here to learn more about our benefits.

Your ideas should inspire change. If you join our team, they will.

Job Summary:

As a member of the Regulatory Compliance Team, the Senior Clinical Auditor will conduct compliance focused clinical audits to ensure compliance with medical necessity, coding, or risk management requirements, as well as support SCA Health's compliance program. The Senior Clinical Auditor will work with all Support Services departments, as well as interact directly with SCA Health's facilities.

Key Responsibilities:

• Perform clinical based (e.g., medical necessity, risk management, CMS' Conditions for Coverage/Conditions of Participation) audits
• Perform Clinical Quality investigations with minimal supervision
• Sufficient knowledge of LCD/NCD requirements
• Complete first level reviews on staff audits or work assigned to peers
• Develop sufficient audit procedures to test controls and business processes
• Lead audits with minimal supervision. As appropriate, assign work tasks to the associate/staff auditor
• Work effectively with other departments/external sources
• Work directly with the supervisor to provide timely communication of audit status
• Work as part of a team who support each other to accomplish set goals and objectives together
• Determine the objective, scope, and general plan of the assigned audit
• Verify the existence of appropriate documentation by the preparation of work papers that adequately summarize the test work performed, observations made, and conclusions reached
• When appropriate, ensure the adequacy of supporting documentation for audit recommendations and findings by performing a detailed review of the work papers of others for accuracy, completeness, the sufficiency of scope, and satisfactory disposition of all issues
• Lead meetings with area management to discuss audit results and recommendations
• Ensure management's response to findings and established time frames for procedure correction/improvement are sufficient to address the identified issue
• Perform follow up with area management to ensure that issues have been addressed and action plans have been implemented
• Be a knowledge resource to staff level teammates
• Travel approximately 6-7 times a year.

• Understanding of coding and medical necessity requirements
• Understanding of Conditions of Participation/Conditions for Coverage requirements
• Understanding of healthcare compliance and compliance related principles
• Excellent planning, analytical, organizational and communication skills are essential
• Flexible attitude and open to changes in the audit schedule
• Absolute attention to detail
• Demonstrated ability to manage multiple projects and tight deadlines
• Excellent teamwork and interpersonal skills
• Demonstrated leadership potential
• Strong mission and values commitment; natural cultural fit

Education and Work Experience:

• Undergraduate Degree in Nursing
• Current RN license
• 4-5 years of experience as a licensed Registered Nurse or equivalent clinical background preferred.
• Additional experience related to audit and or utilization reviews (preferred).

Other considerations (not requirements):

• Certified clinical coder
• Certification in healthcare compliance (CHC)

PI60e9b16b30a1-29448-37327639