RN Nurse Auditor

R0276438

Job Objective:

Responsible for concurrent audits of Medical Record Chart for verification of consistent demographic data and completeness of clinical documentation Responsible for pre-auditing medical records for all accounts scheduled for audits by insurance companies, external audit agencies and/or patient requested audits. Responsible for instituting and leading Process Improvement Teams to record, quantify and correct deficiencies. Represents PFS to share audit finding with exiting Hospital Chart Audit Committee and Hospital Compliance Officer and Committee.

Job Description:

Education:

Required: Bachelor’s degree in Nursing or Master’s degree in Nursing or enrollment in an RN-Bachelor’s degree in Nursing or RN-Master’s degree in Nursing program within 1 year of hire and completion within 5 years of hire if hired after July 1, 2012

Licensure/Certification:

Required: California RN Licensure

Experience:

Required: Experienced Medical Auditor Knowledge of Medical Records and coding
Preferred: Prior Customer Service

Essential Responsibilities:

• Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations. Coordinates medical record audit scheduling with external auditors, medical records and ancillary departments when necessary Meets with external auditors during schedule audits and assists as needed Conducts exit conference with external auditors
• Reports to Compliance Officer and Compliance Committee any patterns seen relative to poor documentation or charting.
• Reports any charging issues that do not conform to current Federal Regulations governing billable/non-billable charges
• Prepares reports on Monthly basis showing: Total Patient/defense and concurrent audits for month with: Total gross charges, over charges/under charges by department, defense results, and final determination, Summary of deficiencies found in medical record charts to include the following: Itemization of issue Current status on correction activities, Attends available seminars pertaining to compliance Issues and guidelines, Medical and Billable Coding and Medical Record Charting
• Provides positive indication that teamwork is a major and important focus of all Eisenhower Medical Center employees.
• Conducts periodic in-service classes for ancillary departments instructing the staff on charge/chart review
• Conducts periodic in-service classes for Patient Financial Services department instructing the staff on common medical terms and errors in charging.
• Performs other job related duties as requested by Supervisor
• Attends staff meeting, in-house training and attends classes pertaining to Federal and State billing regulations as well as Compliance Issues and Guidelines when requested

Essential Skils:

• Effective computer knowledge of MS Word, Excel and database applications
• Familiar with billing and medical records compliance issues as mandated through Federal regulations
• Experience with Hospital cost center charging practices, knowledge of hospital billing and database systems
• Proficient understanding of medical terminology, managed care terminology, and CPT/ICD9 coding
• Excellent verbal and written communication skills; ability to make executive presentations
• Must understand commercial and managed care patient accounting principals