QUARTERLY AUDIT OF HEALTH CENTERS DIVISION PROVIDERS

Clackamas County is seeking proposals from vendors to provide a quarterly audit of Health Centers Division providers for compliance and regulatory requirements. The audit will include reviewing organizational documents and records to verify compliance with regulatory requirements, addressing and supporting coding practices that optimize Health Centers' long-term sustainability, analyzing and supporting risk revalidation efforts, and suggesting opportunities to improve risk coding practices. The contractor will be required to conduct quarterly audits, provide group training sessions, and meet with the Compliance Analyst and Billing Supervisor before and after each audit. The contract term will be from the effective date through December 31, 2030, with the option for two additional two-year renewals. Key aspects of the job include: • Evaluating documentation to ensure it supports the services provided and billed • Assessing the fulfillment of medical necessity for the services reviewed • Conducting a comprehensive review of all relevant coding types • Ensuring compliance with regulatory guidelines for medical documentation and billing • Identifying discrepancies between services documented and services billed to address potential compliance risks • Validating the accuracy of CPT, HCPCS, and ICD-10-CM coding to maintain billing precision