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Clinical Auditor/Coach

LOCATION: Remote
REMOTE ELIGIBLE: Fully Remote
TRAVEL REQUIREMENT: 5% or less
REQUISITION ID: 417
<p>The <strong>Clinical Auditor /Coach&nbsp;</strong>position performs medical record auditing processes to monitor clinical documentation performed by our providers during in-home and/or virtual health assessment visits. &nbsp;The Clinical Auditor/Coach will also facilitate auditor inter-rater reliability sessions, influence clinical documentation remediation, and identify areas to influence and improve Nurse Practitioners’ clinical documentation. &nbsp;</p> <p>The Clinical Auditor/Coach is responsible for ensuring compliance with national clinical protocols, state requirements and Inovalon corporate standards of care.&nbsp; This role will provide specific guidance on clinical documentation improvement opportunities and may provide remediation training on quality issues identified during clinical provider audits. &nbsp;</p> <p><strong>Duties and Responsibilities:</strong></p> <ul> <li>Performs audits of medical records to ensure documentation is complete, consistent, accurate, and timely according to clinical protocols;</li> <li>Compiles information and prepare reports for management;</li> <li>Analyze documentation completion data and submit recommendations to improve quality;</li> <li>Identify opportunities for data tracking, database enhancements, and other effective improvements;</li> <li>Develop and document audit protocols based on clinical findings; this includes but is not limited to documenting the audit process, establishing performance thresholds, developing and updating audit tools and score cards;</li> <li>Partner in conjunction with the CCS Medical Director to assess and identify specific training needs;</li> <li>Review the results of audits of medical records performed by Clinical Auditors;</li> <li>Provide specific one-on-one coaching on quality issues identified in review of the clinical resource’s audit results, communicate practices which are not meeting Inovalon’s documentation standards to the individual clinical resources;</li> <li>Establish and facilitate routine communication and feedback mechanisms for delegated oversight of audit findings to Clinical Management. Additionally, utilize findings and trends to improve policies, procedures and associate comprehension via training;</li> <li>Manage integration of information from multiple sources and competing priorities and maintain focus on organizational goals;</li> <li>Evaluate information for integrity, accuracy, and appropriateness to ensure compliance with regulatory standards;</li> <li>Identify issues, propose methodological solutions, thoroughly analyze information, and present audit findings and implications in a clear and direct manner;</li> <li>Maintain compliance with Inovalon’s policies, procedures and mission statement;</li> <li>Adhere to all confidentiality and HIPAA requirements as outlined within Inovalon’s Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position; and</li> <li>Fulfill those responsibilities and/or duties that may be reasonably provided by Inovalon for the purpose of achieving operational and financial success of the Company.</li> </ul> <p><strong>Job Requirements:</strong></p> <ul> <li>Must be licensed and credentialed RN required;&nbsp;</li> <li>Minimum 2 years of experience as clinical auditor (chat review/quality review) in a health care setting (health plan, hospital or clinical) required;</li> <li>Leadership skills to influence the internal responses to audit results and remediation coaching;</li> <li>Highly organized with demonstrated ability to review, audit, and analyze clinical documentation;</li> <li>Direct knowledge and understanding of the HIPAA regulations/guidelines;</li> <li>Ability to plan, and prioritize multiple activities with keen attention to details;</li> <li>Consistently demonstrate excellent effective time management skills and critical thinking skills;</li> <li>Proficiency in Microsoft Office (Word, Excel, Access, and PowerPoint) and,&nbsp;</li> <li>Excellent written, oral communication and interpersonal relationship building skills.</li> </ul> <p><strong>Education:</strong></p> <ul> <li>Bachelor’s degree in Health Services, Public Health, Nursing or related field; or equivalent experience.</li> </ul> <p><strong>Physical Demands and Work Environment:</strong></p> <ul> <li>Sedentary work (i.e. sitting for long periods of time);</li> <li>Exerting up to 10 pounds of force occasionally and/or negligible amount of force;</li> <li>Frequently or constantly to lift, carry push, pull or otherwise move objects and repetitive motions;</li> <li>Subject to inside environmental conditions; and</li> <li>Travel for this position will include less than 5% locally usually for training purposes.</li> </ul> <p>&nbsp;</p><div class="content-conclusion"><p><em>The Company maintains a drug free work environment for all of its associates, which includes employees, contractors and vendors. It is unlawful for associates to manufacture, sell, distribute, dispense, possess or use any controlled substance or marijuana in the workplace and doing so will result in disciplinary action, up to and including termination of employment or the contracted relationship. </em></p> <p><em>By embracing diversity, equity and inclusion we enhance our work environment and drive business success. Inovalon strives to reflect the diversity of the communities where we operate and of our clients and everyone whom we serve. We endeavor to create a culture of inclusion in which our associates feel empowered to bring their full, authentic selves to work and pursue their professional goals in an equitable setting. We understand that by fostering this type of culture, and welcoming different perspectives, we generate innovation and growth.</em></p></div>

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