Governmental Audit Reviewer
Company: LHC Group, Inc.
Posted on: May 3, 2021
The Governmental Audit Reviewer is responsible for the audit,
submission, and appeal of clinical documentation associated with
home health, hospice, LTACHs, and community based services, in
response to external payer inquiries, denials, and requests for
clinical documentation. Payer inquiries include, but are not
limited to any and all pre and or post payment audits, such as:
ADRs, CERTs, RACs, ZPICs, etc.
- Conducts thorough clinical review and submits all necessary
Home Health, Hospice, Community Based Services and LTACH
documentation in response to medical records requests from payers
such as: ADRs, RACs, CERTs, ZPICs, etc.
- Maintains a standardized approach to clinical review that
maximizes inter-rater reliability.
- Composes professionally formatted letters for submission to the
- Is responsible and accountable for initial and, if needed,
final internal review determinations that establish the decision to
appeal any external audit denials.
- Assists with the management of the appeal process of external
review denials to include assignment of appeals and ensuring appeal
deadlines are met.
- Prepares clinical documentation for and participates in
Administrative Law Judge hearings to defend payment of denied
- Maintains a current and working knowledge of relevant issues,
laws and regulations through relevant websites, periodicals,
seminars, training programs, and peer contact. This includes state
and Federal regulations governing compliance and
- Maintains current knowledge of relevant LHC Group policies and
procedures related to Compliance, Performance Improvement, Clinical
Documentation, Internal Audit, etc.
- Works with other LHC department's Directors and Managers to
coordinate team's activities such that there is a minimum
disruption to day-to-day operations.
- Works with established LHC processes to communicate trends
based on audit findings to promote organization-wide corrective
action and behavioral changes.
- Works with the Governmental Audit Supervisor and Governmental
Audit Team to ensure government pay backs as determined through
established audit process and procedure.
- Assists Governmental Audit Supervisor as needed with any
additional Compliance Audits .
- Performs other duties as assigned.
Education & Experience
F ormal Education :
Experience : 5 years
License, Registration, and / or Certification Requirement: Current
license and registration to practice as a licensed practical nurse
or registered nurse.
- Degree in Nursing required.
- Minimum of one (1) to five (5) years' experience in hospice,
LTAC, and-or home health care, with current and working knowledge
of reimbursement and compliance rules and regulations. Experience
with auditing and analyzing clinical documentation preferred.
- Proficient skills in all Microsoft Office applications (Word,
- Evidence of leadership qualities and effective communication
- Ability to relate and work well with others within each level
of authority and responsibility.
- Ability to efficiently work independently and meet productivity
- Strong critical thinking skills.
- Ability to easily adapt to frequent process changes.
Our company was founded over 20 years ago on the principle that
its all about helping people, and we live by those words today. Its
our mission to provide exceptional care and unparalleled service to
patients and families who have placed their trust in us. We grow to
fulfill this mission. When you become part of the LHC Group family,
youre choosing a career path that will challenge you to grow both
personally and professionally.
Every day, all across the country, our LHC Group family is helping
people. There are 10,000 of us, standing shoulder to shoulder,
helping the patients in our care live, fuller, healthier lives. We
do this because helping people is, quite simply, the reason we
exist. Its our purpose.
Keywords: LHC Group, Inc., Lafayette , Governmental Audit Reviewer, Other , Lafayette, Louisiana
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