Senior Internal Quality Auditor

Texas, United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare Staffing, Talent SolutionsIndustries

Requirements

Candidates must possess a Bachelor's Degree with 2-5 years of experience or a High School Diploma/GED with 6-9 years of experience. Preferred certifications include Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), or Certified Documentation Improvement Practitioner (CDIP). Experience in medical coding, auditing, healthcare billing, accounting, or equivalent is required, along with proficiency in various encoder, computer-assisted coding, and electronic health records software.

Responsibilities

The Senior Internal Quality Auditor will perform coding and clinical documentation integrity audits to ensure compliance with regulations. They will serve as an expert resource for the internal quality review team, coders, and managers, identifying incorrect coding and providing feedback. Responsibilities include performing concurrent, prebill, and retrospective reviews, auditing for appropriate clinical documentation to support diagnosis capture and level of service, and reviewing medical records for consistent documentation across all payer types. The auditor will also provide recommendations for improvement, maintain productivity standards, complete audits within established timeframes, and adhere to relevant policies.

Skills

Coding Audits

Clinical Documentation Integrity (CDI)

Federal Regulations

State Regulations

Medical Records Review

Diagnosis Capture

Payer Types

CMS

Actriv Healthcare

Connects healthcare facilities with nursing professionals

About Actriv Healthcare

Actriv Healthcare connects healthcare facilities with nursing professionals through a digital platform designed for healthcare staffing. The platform allows nursing professionals to create their own schedules, select preferred workplaces, and contribute to patient care. Users download the Actriv app, complete their application, upload credentials, and schedule an interview. Once approved, they can choose shifts that fit their availability, clock in and out for work, and receive payment, along with benefits like vacation and sick time. Actriv stands out from competitors by emphasizing flexibility in work schedules and leveraging technology to streamline the staffing process. The company's goal is to enhance patient care by providing healthcare facilities with the staffing solutions they need while offering nursing professionals the flexibility they desire.

Tacoma, WashingtonHeadquarters

2017Year Founded

$243.2KTotal Funding

DEBTCompany Stage

HealthcareIndustries

51-200Employees

Benefits

Professional Development Budget

Risks

Rising competition from similar healthcare staffing platforms threatens market share.

AI-driven staffing solutions may reduce need for traditional platforms like Actriv.

Potential labor law changes could impact Actriv's business model.

Differentiation

Actriv offers a unique platform for flexible nursing work schedules.

The company provides a seamless app experience for healthcare professionals.

Actriv's platform emphasizes matching skilled professionals with patient care needs.

Upsides

Actriv secured $3.9M for expansion in Tacoma, boosting growth potential.

Four-year streak on Inc. 5000 highlights Actriv's rapid growth and success.

Increased demand for flexible work aligns with Actriv's business model.

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