Medical Staff Auditor

Vanderbilt University Medical Center
Published
September 22, 2022
Location
Trenton, NJ
Category
Job Type

Description

Medical Staff Auditor - 2208705

**Job** : Medical Coding and Billing

**Primary Location** : Work from Home

**Organization** : Provider Credentialing 30 200607

**Shift:** : First Shift

**Description**

**Medical Staff Auditor**

**JOB SUMMARY:**

Ensures credentialing and privileging activities comply with requirements of regulatory and accrediting agencies including the Centers for Medicare/Medicaid Services, the Joint Commission, and the National Committee for Quality Assurance, federal and state laws and delegated credentialing agreements independently. Executes the Medical Staff Office Quality Assurance Program.

**KEY RESPONSIBILITIES:**

+ Audits credentials files and verifies information entered in information systems.

+ Maintains and analyzes quality data, identifies trends, and recommends corrective actions.

+ Coordinates external audit engagements and responding to complex inquiries.

+ Prepares and submits material for external audits and Corrective Action Plans.

+ Serves as primary contact for VHAN.

+ The responsibilities listed are a general overview of the position and additional duties may be assigned.

**TECHNICAL CAPABILITIES:**

_DISCRETION & PRIVACY (ADVANCED):_ - The ability to use and keep information confidential in a secure setting.

_DATA ENTRY (ADVANCED):_ - The ability to transcribe information from the original source into an electronic system according to written and verbal instructions efficiently and accurately.

_ANALYTICAL SKILLS (ADVANCED):_ - The process of identifying, evaluating, interpreting and organizing data. It includes sorting through data to identify patterns and establish relationships for decision making.

_CVO POLICIES AND PROCEDURES (INTERMEDIATE):_ - Knowledge, adherence and application of CVO policies and procedures.

_PROCESS DEVELOPMENT (ADVANCED):_ - Identifies, analyzes and improves upon existing business processes for optimization and to meet standards of quality.

**CORE ACCOUNTABILITIES:**

+ Organizational Impact: Independently performs non-routine tasks that significantly impact team and other related teams.

+ Problem Solving/ Complexity of work: Gathers and analyzes data to solve problems that arise with little or no precedent.

+ Breadth of Knowledge: Applies advanced job knowledge and has developed a breadth of skills in other areas.

+ Team Interaction: Serves as a lead for the team by providing expertise and guidance to team members.

**CORE CAPABILITIES:**

SUPPORTING COLLEAGUES (S4):

+ - Develops Self and Others: Invests time, energy and enthusiasm in developing self/others to help improve performance and gain knowledge in new areas.

+ - Builds and Maintains Relationships: Maintains regular contact with key colleagues and stakeholders using formal and informal opportunities to expand and strengthen relationships.

+ - Communicates Effectively: Recognizes group interactions and modifies one's own communication style to suit different situations and audiences.

DELIVERING EXCELLENT SERVICES (S4):

+ - Serves Others with Compassion: Seeks to understand current and future needs of relevant stakeholders and customizes services to better address them.

+ - Solves Complex Problems Approaches problems from different angles; Identifies new possibilities to interpret opportunities and develop concrete solutions.

+ - Offers Meaningful Advice and Support: Provides ongoing support and coaching in a constructive manner to increase employees' effectiveness.

ENSURING HIGH QUALITY (S4):

+ - Performs Excellent Work: Engages regularly in formal and informal dialogue about quality; directly addresses quality issues promptly.

+ - Ensures Continuous Improvement: Applies various learning experiences by looking beyond symptoms to uncover underlying causes of problems and identifies ways to resolve them.

+ - Fulfills Safety and Regulatory Requirements: Understands all aspects of providing a safe environment and performs routine safety checks to prevent safety hazards from occurring.

MANAGING RESOURCES EFFECTIVELY (S4):

+ - Demonstrates Accountability: Demonstrates a sense of ownership, focusing on and driving critical issues to closure.

+ - Stewards Organizational Resources: Applies understanding of the departmental work to effectively manage resources for a department/area.

+ - Makes Data Driven Decisions: Demonstrates strong understanding of the information or data to identify and elevate opportunities.

FOSTERING INNOVATION (S4):

+ - Generates New Ideas: Proactively identifies new ideas/opportunities from multiple sources or methods to improve processes beyond conventional approaches.

+ - Applies Technology: Demonstrates an enthusiasm for learning new technologies, tools, and procedures to address short-term challenges

+ - Adapts to Change: Views difficult situations and/or problems as opportunities for improvement; actively embraces change instead of emphasizing negative elements.

**Basic Qualifications**

High School Diploma or GED (or equivalent experience) and 5 years relevant experience

**Licensure, Certification, and/or Registration (LCR):**

**Physical Requirements/Strengths needed & Physical Demands:**

+ Sedentary category requiring exertion up to 10 lbs. of force occasionally and uses negligible amounts of force to move objects. Sedentary work involves sitting most of the time.

**Movement**

+ Occasional: Standing: Remaining on one's feet without moving.

+ Occasional: Walking: Moving about on foot.

+ Occasional: Lifting under 35 lbs: Raising and lowering objects under 35 lbs from one level to another

+ Occasional: Carrying under 35 lbs: Transporting an object holding in hands, arms or shoulders, with help of coworkers or assistive device.

+ Occasional: Push/Pull: Exerting force to move objects away from or toward.

+ Occasional: Reaching above shoulders: Extending arms in any direction above shoulders.

+ Frequent: Sitting: Remaining in seated position

+ Frequent: Reaching below shoulders: Extending arms in any direction below shoulders.

+ Frequent: Fingering: Picking, pinching, gripping, working primarily with fingers requiring fine manipulation.

+ Frequent: Bimanual Dexterity: Requiring the use of both hands.

**Sensory**

+ Continuous: Communication: Expressing or exchanging written/verbal/electronic information.

+ Continuous: Auditory: Perceiving the variances of sounds, tones and pitches and able to focus on single source of auditory information

+ Continuous: Vision: Clarity of near vision at 20 inches or less and far vision at 20 feet or more with depth perception, peripheral vision, color vision.

+ Continuous: Smell: Ability to detect and identify odors.

**Environmental Conditions**

+ Occasional: Chemicals and Gasses: Medications, cleaning chemicals, oxygen, other medical gases used in work area.

**Req ID:** 2208705

Vanderbilt University Medical Center is committed to principles of equal opportunity and affirmative action.

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