Clinical Auditor

Tenet Healthcare • Detroit, MI

1d • Onsite

About The Position

Under limited direction and according to established policies and procedures conducts audits of hospital bills and medical records. Ensures documented charges are correctly billed and billed charges are documented in the medical record. Corrects billing errors in the Patient Accounting system and in some cases, the Cerner system. Identifies, reports and recommends actions to improve charge capture processes. Identifies new services and technology in the clinical setting and facilitates establishment of new charges. Conducts in-service training for hospital personnel to ensure understanding of the importance of effective charge capture and documentation of services performed. Conducts complex reviews of departmental processes which include registration, clinical activities, documentation and charge capture. Identifies opportunities to maximize billing in accordance with federal and state regulations. Safeguards the assets of the DMC, advocates appropriate levels of internal control and promotes operating effectiveness and efficiency. Defend the hospitals revenue through research, documentation and negotiation by participating in and acting as a content expert for the hospital in audits conducted by third parties including, but not limited to, Blue Cross Catastrophic audits; HOPP audits; MPRO audits and all commercial insurance audits. Provides both clinical and technical/billing expertise and acts as liaison and resource for user departments. Analyzes results, identifies trends and patterns and prepares monthly statistical and narrative reports for various levels of hospital and corporate management.

Requirements

• Bachelor's Degree in Nursing.
• Licensed Registered Nurse in the State of Michigan.
• Three years of patient care experience in a hospital as a Registered Nurse, at least one of which should be in a critical patient care specialty area such as I.C.U., E.R. or O.R.

Nice To Haves

• Charge audit or similar experience preferred.
• One year experience as a Clinical Auditor.

Responsibilities

• Conducts audits of hospital bills and medical records.
• Ensures documented charges are correctly billed and billed charges are documented in the medical record.
• Corrects billing errors in the Patient Accounting system and in some cases, the Cerner system.
• Identifies, reports and recommends actions to improve charge capture processes.
• Identifies new services and technology in the clinical setting and facilitates establishment of new charges.
• Conducts in-service training for hospital personnel to ensure understanding of the importance of effective charge capture and documentation of services performed.
• Conducts complex reviews of departmental processes which include registration, clinical activities, documentation and charge capture.
• Identifies opportunities to maximize billing in accordance with federal and state regulations.
• Safeguards the assets of the DMC, advocates appropriate levels of internal control and promotes operating effectiveness and efficiency.
• Defends the hospitals revenue through research, documentation and negotiation by participating in and acting as a content expert for the hospital in audits conducted by third parties including, but not limited to, Blue Cross Catastrophic audits; HOPP audits; MPRO audits and all commercial insurance audits.
• Provides both clinical and technical/billing expertise and acts as liaison and resource for user departments.
• Analyzes results, identifies trends and patterns and prepares monthly statistical and narrative reports for various levels of hospital and corporate management.

Benefits

• Medical, dental, vision, and life insurance
• 401(k) retirement savings plan with employer match
• Generous paid time off (PTO)
• Career development and continuing education opportunities
• Health savings accounts, healthcare C dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder C childcare, auto C home insurance.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level