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The Director of Auditing and Education at WVU Medicine is a pivotal role responsible for overseeing project leadership, managing external-facing auditor/educators, and fostering productive relationships with both providers and senior management. This position requires significant regional travel, ready to address local education needs in reimbursement areas across several facilities. Key responsibilities include enhancing provider communication and improving the overall quality and capture of appropriate documentation. The role is central to the development and implementation of strategies connecting provider documentation to the mid-revenue cycle.
MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Master’s degree in healthcare administration, Health Information Management, Health Informatics or other related field AND Two (2) years of experience in a leadership role OR;
2. Bachelor’s degree in Heath Information Management or a related field. Successful completion and maintenance of the Registered Health Information Administrator (RHIA) Exam AND Four (4) years of experience in a leadership role OR;
3. Bachelor of Science in Nursing (BSN) AND West Virginia Registered Nurse licensure AND Four (4) years of experience in a leadership role
PREFERRED QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. A certification in Clinical Documentation Integrity
EXPERIENCE:
1. Previous supervisory or project management experience.
2. Seven (7) years of Health Information Management or Nursing experience.
3. Direct responsibility of Coding Audit and Education experience.
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and
duties. Other duties may be assigned.
1. Strategic Planning and Leadership
a. Establishes appropriate goals in conjunction with VP of EIM and system wide CMO, CMIO and CFO leaders. Assures that goals are clearly communicated to audit and education managers and staff.
b. Analyzes and establishes strategic plans to ensure system-wide audit/education is progressive in reference to regulations set forth at the federal and local level.
c. Utilizes analytics to set strategy, working with, Strategic initiatives/SSL, Business Analytics and Information Technology to assess operations and react quickly to growth and acquisitions.
2. Relationship Management and Collaboration
a. Collaborates and maintains a positive relationship with the Medical Staff, Coding Teams, CDI, Center for Quality Outcomes, Revenue Cycle Leadership teams, Information Technology and Senior Level Management at all WVU Medicine Physician Practice Plans and Hospitals, as well as the WVU Health System.
b. Coordinate with all other EIM Directors to develop and maintain system-wide Audit/Education guidelines and documentation requirements.
c. Continually communicates with CDI leadership, Coding leadership, Medical Staff, Medical Director, Physician Advisors, Department Chairpersons, Department Administrators, and Population Health.
3. Training and Education Programs
a. Provides strategic guidance and direction for system-wide audit/education services; create and manage strong culture by recruiting, training, and retaining motivated competent managers and staff. Participates in appropriate committees and evaluates the need for outside audits to assure compliance.
b. Establishes the strategy of training education programs and assures training programs are implemented to recruit and manage for future growth.
c. Provides actionable feedback on individual documentation and coding performance.
4. Quality Assurance and Compliance
a. Responsible for evaluating trends with reference to Edits and Denials, RVUs, HCCs, DRGs, including Mortality and Comorbidities to determine the necessity of education needed.
b. Leads the analysis and response to any audit findings or discrepancies, ensuring that corrective measures are implemented in a timely and effective manner.
c. Serves as expert clinical and coding resource from a professional, clinic and facility perspective.
d. Responsible for the planning, development, and implementation of a provider education initiative that connects the principles and regulations associated with professional, hospital based and quality documentation needs.
5. Regulatory Compliance and Performance Metrics
a. Ensures audit and education staff are up to date on all regulatory requirements and integrates these into comprehensive performance metrics. Manages the creation and use of these metrics to maintain appropriate quality and productivity, aligning staff performance with WVU Medicine's strategic objectives and regulatory compliance.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Ability to sit for extended periods of time.
2. Have finger dexterity and complete use of hands, arms, and feet.
3. Must have visual and hearing acuity within the normal range.
5. Will require travel.
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to
perform the essential functions.
1. This position requires frequent travel to meet with providers and manage educational activities across various WVU Medicine locations, ensuring effective implementation and oversight of audit and education services system-wide.
2. Standard office environment.
3. Visual strain may be encountered in viewing computer screens, spreadsheets, and other written material.
SKILLS AND ABILITIES:
1. Strong interpersonal communication and presentation skills, effectively presenting information to management, faculty practice groups and individuals.
2. Must possess knowledge of related provider healthcare compliance, revenue cycle operations, and auditing techniques required.
3. Must possess the ability to mentor, educate, and train others.
4. Must meet quality and productivity standards.
5. Must be able to handle high-stress and critical situations calmly and professionally.
6. Must be able to concentrate and maintain accuracy during constant interruptions.
7. Must possess independent decision-making ability.
8. Must possess the ability to prioritize job duties.
9. Must be able to adapt to changes in the workplace and work assignments.
10. Must possess knowledge of anatomy, physiology, and medical terminology.
11. Must possess analytical and problem-solving skills.
12. Must be proficient in office software programs.
13. Must possess the ability to analyze complex data and reports.
14. Strong understanding of Epic.
15. Excellent organizational and project management skills.
16. Strong time management, attention to detail, and follow-through. Well-developed research skills. 17. Strong knowledge of revenue cycle process, revenue integrity, denials, coding, document improvement and its impact throughout the revenue cycle.
Additional Job Description:
Scheduled Weekly Hours:
40
Shift:
Exempt/Non-Exempt:
United States of America (Exempt)
Company:
SYSTEM West Virginia University Health System
Cost Center:
546 SYSTEM HIM
