• Directly supports the responsibilities of the Coding and documentation quality assurance (CDQA) team: implementation of and compliance to enterprise-wide and department coding policies and procedures for PHS. • Compliance to all external regulatory agency coding rules and regulations. • Demonstrates high-level of proficiency in performing and/or managing on-site internal audits or reviews to assess compliance/quality monitoring performed by PHS/PMG departments. • Serves as a resource on documentation, coding, billing, and coding compliance questions. • Works on special coding compliance related projects, develops and presents educational programs, disseminates information to PHS/PMG departments and develops educational tools used to maintain compliance with regulations. • Provides support via auditing and training the enterprise-wide corrective action plans for coding, audit, physician and clinician personnel identified as low performers. • Perform medical record and billing reviews of denied and appealed claims and takes appropriate action to ensure accurate payment of claims. • Coordinate review and tracking of appealed claims including the communication process with affected payers. • Research and interpret all regulatory agency regulations. • Liaison to the Manager, Information Services, Finance/Patient Financial Services, all hospitals, all PMG sites, PHP, Home Health, Albuquerque Ambulance, Compliance and all ancillary departments in addressing functional coding, auditing, compliance and training issues and problems. • Interact with all levels of management responsible for maintaining accurate, complete and timely documentation in either electronic or hard copy form. • Maintains and disseminates up-to-date technical knowledge of legal and regulatory information from all appropriate jurisdictions concerning the given business area. • Researches coding, billing and charging compliance issues, recommends and implements corrective action plans that assure compliance with regulatory agencies where appropriate. • Identifies risks, develops and follows up on action plans, identifies lost revenue opportunities and any overpayments due to errors in coding and/or documentation, and provides compliance education. • Assists in the creation of the CDQA Annual Audit Work-plan by utilizing the OIG work plan, Medicare and Medicaid regulations, RAC and other audit agency focuses, and internal and external risk assessments. • Regularly exercise independent judgment in determining the reliability of data reviewed; recommends changes in existing practices to gain or maintain compliant behavior. • Keeps actively informed on the business climate of the healthcare industry. • Responds to inquiries and requests daily regarding coding and auditing issues and problems and ad-hoc analysis for all PHS management.

• Conduct on-site clinical walkthroughs and evaluate the quality and compliance of medical care provided in monitored facilities. • Interview facility healthcare staff and residents to collect high-quality data regarding medical services and living conditions. • Synthesize complex medical findings and clinical data into clear, actionable reports that identify deficiencies and conform to federal oversight standards. • Create comprehensive workpapers and draft specialized sections of site-specific reports that outline medical deficiencies and recommendations. • Coordinate closely with Senior Inspectors and Lead Auditors to successfully integrate medical oversight findings into the team's inspection activities, reports, and final draft reports. • Maintain absolute confidentiality and safeguard sensitive information, including protected health information and PII, collected during fieldwork. • Maintain high physical and logistical readiness, capacity to walk 15,000+ steps, stand for 8–10 hours, and carry equipment through various facility terrains.

• Perform regularly scheduled in plant audits as requested by the Regional Inspection Manager. • Perform on-site scheduled audits as requested by Regional Inspection Manager. • Perform product sampling as requested by Regional Inspection Manager • Continually monitor the client’s implementation of approved quality systems. • Continually evaluate and communicate the status of each client’s quality system to the Regional Inspection Manager. • All inspection reports will be sent to the Regional Inspection Manager for review by the end of each month. • Establish excellent relationships with States and HUD to ensure we are respected as a leader and partner. • Ensure all applicable ICC NTA procedures are consistently followed in the execution of inspection jobs. • Continually identify, recommend, and pursue opportunities for process improvements within the Department and ICC NTA. • Promote effective communication throughout the organization. • Identify opportunities and recommend actions that will enhance communication among all employees. • Contribute on an ongoing basis, insights and ideas for resolving repetitive issues as they arise in the field by establishing and maintaining a consistent line of communication with Inspection Managers. • Perform other duties, responsibilities, and special assignments as directed by the Regional Inspection Manager.

• Perform regularly scheduled in plant audits as requested by the Regional Inspection Manager. • Perform on-site scheduled audits as requested by Regional Inspection Manager. • Perform product sampling as requested by Regional Inspection Manager • Continually monitor the client’s implementation of approved quality systems. • Continually evaluate and communicate the status of each client’s quality system to the Regional Inspection Manager. • All inspection reports will be sent to the Regional Inspection Manager for review by the end of each month. • Establish excellent relationships with States and HUD to ensure we are respected as a leader and partner • Ensure all applicable ICC NTA procedures are consistently followed in the execution of inspection jobs. • Continually identify, recommend, and pursue opportunities for process improvements within the Department and ICC NTA. • Promote effective communication throughout the organization. • Identify opportunities and recommend actions that will enhance communication among all employees. • Contribute on an ongoing basis, insights and ideas for resolving repetitive issues as they arise in the field by establishing and maintaining a consistent line of communication with Inspection Managers. • Perform other duties, responsibilities, and special assignments as directed by the Regional Inspection Manager.