Compliance Nurse Auditor

University of Missouri • Columbia, MO

91d • $75,275 - $109,553

About The Position

The Compliance Nurse Auditor utilizes clinical expertise, compliance best practices, and critical thinking skills to review encounter-level clinical documentation, coding and billing records, and organizational policies and procedures to monitor and assess compliance with relevant rules, regulations, and requirements, and assists with ensuring revenue integrity. The Office of Corporate Compliance (OCC) is the hospital's resource for coding and processes to maintain compliance with government regulations. Information obtained, researched, and maintained within the OCC is of a sensitive nature and highly confidential. All professional staff must have high integrity, job knowledge, and practice confidentiality of MU Health Care matters.

Requirements

• Missouri Board of Nursing RN or Nurse Licensure Compact multi-state RN.
• Five (5) years of experience in healthcare or a related field.
• Certification in one of the following within two (2) years as a condition of continued employment: Certified Healthcare Compliance (CHC), Certified Internal Auditor (CIA), Certified Fraud Examiner (CFE), Certified Professional Medical Auditor (CPMA), Certified Professional Compliance Officer (CPCO), Certified Professional Coder (CPC) and Certified Professional Biller (CPB).

Nice To Haves

• Master's degree.
• Three (3) years of experience using electronic medical records.
• Experience with Cerner.

Responsibilities

• Evaluates clinically related revenue integrity activities through routine audits, ad hoc clinical audit requests, and answering questions.
• Assesses encounter-level clinical documentation for relevant compliance matters such as medical necessity, documentation, appropriateness of clinical documentation, and integrity with account charging, coding, and billing.
• Performs assigned audits of medical records, reviews hospital and professional charges and documentation, and ensures compliance with regulatory requirements.
• Plans and presents audit and investigation results to departmental leadership to discuss findings and recommendations.
• Plans, conducts, and completes reviews in other areas of compliance and related operations as identified in the risk assessment process.
• Works closely with revenue cycle, physicians, and other key management personnel throughout the system to improve coding, billing, and clinical documentation compliance.
• Analyzes clinical documentation and makes recommendations to promote, maintain, and/or improve organizational compliance, including providing education to departments, leadership, and providers.
• Investigates compliance matters and collaborates with department leaders and staff to provide guidance on compliance requirements and relevant findings.
• Provides training and acts as a resource to physicians, non-physician providers, support staff, administration, and other personnel on compliance with federal and state regulations and guidelines.
• Identifies and provides feedback regarding missing, incomplete, unclear, or conflicting clinical documentation.
• Collates findings and recommendations into compliance reports which are distributed to departmental and organizational leadership.
• Assists with managing data, data analytics, and information systems for the Office of Corporate Compliance (OCC).

Benefits

• Health, vision and dental insurance coverage starting day one.
• Generous paid leave and paid time off, including nine holidays.
• Multiple retirement options, including 100% matching up to 8% and full vesting in three years.
• Tuition assistance for employees (75%) and immediate family members (50%).
• Discounts on cell phone plans, rental cars, gyms, hotels and more.

What This Job Offers

• Job Type: Full-time
• Industry: Educational Services
• Education Level: Bachelor's degree