Position Summary:

The CVO Auditor conducts an onsite review of the practitioner’s office and medical records. This role will provide specific guidance on improvement opportunities through communicating the deficiencies found during the onsite review, offering the practitioners an opportunity to improve its operations. The CVO Auditor ensures that the practitioner was given a copy of the onsite summary audit report and develop a corrective action plan to share with providers to assist them in documenting corrected deficiencies (as applicable).

 

Essential Functions:   

1. Performs audits of medical records to ensure that documentation is complete, consistent, and accurate and performs a summary report for the practitioner. (10%)
2. Evaluate the office where practitioners offer services. (10%)

3. Compiles information and prepare reports for the supervisor.

4. Analyzes documentation completion data and submits recommendations to improve quality and Identifies opportunities for effective improvements. 

5. Conducts an onsite “exit summary” to review the outcome of the site visit with the practitioner and provides coaching on quality issues identified in review. 

6. Manage integration of information from multiple sources and competing priorities and maintain focus on organizational goals.  
7. Evaluate information for integrity, accuracy, and appropriateness ensuring compliance with regulatory standards. Develop a corrective action plan template to share with providers to assist them in documenting corrected deficiencies (as applicable). 

8. Upload the outcomes/findings into a report that may be analyzed for patterns of deficiencies that may provide opportunities for an error reduction quality improvement project (QIP). 

      9. Complies with all federal and state regulations and guidelines established by the Centers for Medicare and Medicaid (CMS), NCQA and guidelines set forth by other regulatory agencies, where           

           applicable.

 

    10. In addition, all other duties assigned by the manager and/or supervisor. 

Education:

• Master or Doctorate degree in behavioral health or related field.
• Current, unrestricted license to practice

 

Experience:  

• Minimum 2 years of experience in management care field preferred.

 

Knowledge:  

• Knowledge in quality indicators, measures and improvement activities.
• Knowledge and experience in auditory process 
• Knowledge and experience in credentialing with basic knowledge of credentialing process and procedures preferred.
• Knowledge of Health Plan Credentialing requirements preferred.
• Knowledge of NCQA and CMS requirements preferred.
• Personal computer experience should include working with Microsoft Word, Excel, Power Point and Outlook at the intermediate level at a minimum.

EEO
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