Senior Clinical Auditor

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Senior Clinical Auditor

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Birmingham, Alabama
Surgical Care Affiliates
Medical & Clinical Ops
Regular
Full-time
1
USD $85,000.00/Yr.
USD $95,000.00/Yr.
39797

SCA Health

Job Description

Overview

At SCA Health, we believe health care is about people – the patients we serve, the physicians we support and the teammates who push us forward. Behind every successful facility, procedure or innovation is a team of 15,000+ professionals working together, learning from each other and living out the mission, vision and values that define our organization.

As part of Optum, SCA Health is redefining specialty care by developing more accessible, patient-centered practice solutions for a network of more than 370 ambulatory surgical centers, over 400 specialty physician practice clinics and numerous labs and surgical hospitals. Our work spans a broad spectrum of services, all designed to support physicians, health systems and employers in delivering efficient, value-based care to patients without compromising quality or autonomy.

What sets SCA Health apart isn’t just what we do, it’s how we do it . Each decision we make is rooted in seven core values :

Clinical quality
Integrity
Service excellence
Teamwork
Accountability
Continuous improvement
Inclusion

Our values aren’t empty words – they inform our attitudes, actions and culture. At SCA Health, your work directly impacts patients, physicians and communities. Here, you’ll find opportunities to build your career alongside a team that values your expertise, invests in your success, and shares a common mission to care for patients, serve physicians and improve health care in America.

At SCA Health, we offer a comprehensive benefits package to support your health, well-being, and financial future. Our offerings include medical, dental, and vision coverage, 401k plan with company match, paid time off, life and disability insurance, and more. Click here to learn more about our benefits.

Your ideas should inspire change. If you join our team, they will .

Responsibilities

Job Summary:

As a member of the Regulatory Compliance Team, the Senior Clinical Auditor will conduct compliance focused clinical audits to ensure compliance with medical necessity , coding , or risk management requirements , a s well as support SCA Health’ s compliance program . The Senior Clinical Auditor will work with all Support Services departments , as well as interact directly with SCA Health ’s facilities.

Key Responsibilities:

Perform clinical based (e.g., medical necessity, risk management, CMS’ Conditions for Coverage/Conditions of Participation) audits
Perform Clinical Quality investigations with minimal supervision
Sufficient knowledge of LCD/NCD requirements
Complete first level reviews on staff audits or work assigned to peers
Develop sufficient audit procedures to test controls and business processes
Lead audits with minimal supervision. As appropriate , assign work tasks to the associate/staff auditor
Work effectively with other departments/external sources
Work directly with the supervisor to provide timely communication of audit status
Work as part of a team who support each other to accomplish set goals and objectives together
Determine the objective , scope, and general plan of the assigned audit
Verify the existence of appropriate documentation by the preparation of work papers that adequately summarize the test work performed, observations made, and conclusions reached
When appropriate , ensure the adequacy of supporting documentation for audit recommendations and findings by performing a detailed review of the work papers of others for accuracy, completeness, the sufficiency of scope, and satisfactory disposition of all issues
Lead meetings with area management to discuss audit results and recommendations
Ensure management’s response to findings and established time frames for procedure correction/improvement are sufficient to address the identified issue
Perform follow up with area management to ensure that issues have been addressed and action plans have been implemented
Be a knowledge resource to staff level teammates
Travel approximately 6-7 times a year.

Qualifications

Understanding of coding and medical necessity requirements
Understanding of Conditions of Participation/Conditions for Coverage requirements
Understanding of healthcare compliance and compliance related principles
Excellent planning, analytical, organizational and communication skills are essential
Flexible attitude and open to changes in the audit schedule
Absolute attention to detail
Demonstrated ability to manage multiple projects and tight deadlines
Excellent teamwork and interpersonal skills
Demonstrated leadership potential
Strong mission and values commitment; natural cultural fit

Education and Work Experience:

Undergraduate Degree in Nursing
Current RN license
4-5 years of experience as a licensed Registered Nurse or equivalent clinical background preferred.
Additional experience related to audit and or utilization reviews (preferred).

Other considerations (not requirements):

Certified clinical coder
Certification in healthcare compliance (CHC)

USD $85,000.00/Yr. USD $95,000.00/Yr.

PI7f9d6750f8c7-35196-37327639

SCA Health Glassdoor Company Review

3.6

SCA Health DE&I Review

No rating

CEO of SCA Health

Jason Strauss

Approve of CEO

Average salary estimate

$90000 / YEARLY (est.)

min

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$85000K

$95000K

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What You Should Know About Senior Clinical Auditor, SCA Health

If you're ready to take your career to the next level as a Senior Clinical Auditor with SCA Health, this is your chance! Located in beautiful Myrtle Point, Oregon, you'll be a crucial part of a dedicated Regulatory Compliance Team. Your primary role will involve conducting compliance-focused clinical audits, ensuring that everything from medical necessity to coding and risk management meets regulatory standards. At SCA Health, we're passionate about redefining specialty care and believe that our team of over 15,000 professionals impacts everything we do. Here, you’ll engage in clinical quality investigations, collaborate with various departments, and develop audit procedures that enhance our processes. Your expertise will guide us in delivering patient-centered care through our expansive network of surgical centers and clinics. We value integrity, accountability, and continuous improvement, so your insights will truly matter. You can look forward to a flexible work environment where you'll showcase your planning and analytical skills as you manage multiple projects. Plus, with a comprehensive benefits package including excellent healthcare, paid time off, and 401k matching, you’ll feel supported in your professional journey. If you value teamwork and want to make a difference, we invite you to join our mission at SCA Health, where your work goes beyond numbers and directly impacts patients and communities. Let's inspire change together!

Frequently Asked Questions (FAQs) for Senior Clinical Auditor Role at SCA Health

What are the primary responsibilities of a Senior Clinical Auditor at SCA Health?

As a Senior Clinical Auditor at SCA Health, your primary responsibilities include conducting compliance-focused clinical audits, engaging in clinical quality investigations, and collaborating with various departments to ensure medical necessity and coding compliance. You will lead audits, verify documentation, and provide recommendations based on your findings. Your work will directly impact the quality of patient care across our network.