Compliance Nurse Auditor

Saint Francis Health System

4d • Onsite

About The Position

The Compliance Nurse Auditor assists with and supports the compliance program activities within Saint Francis Health System (SFHS). This role supports clinical coding and billing audit functions as well as the performance of routine and complex audits, oversight activities, and coordinates remediation and corrective action plans.

Requirements

• Has completed the basic professional curricula of a school of nursing as approved and verified by a state board of nursing, and holds or is entitled to hold a diploma or degree therefrom.
• Valid multi-state or State of Oklahoma Registered Nurse License.
• Minimum 3 years of healthcare compliance clinical auditing experience within a hospital setting.
• Deep understanding of medical necessity, documentation standards, and clinical validation.
• Highly detail-oriented with strong critical-thinking and analytical skills.
• Ability to apply audit methodology consistently and defensibly.
• Comfortable reviewing large volumes of medical records and data.
• Collaborative approach with Compliance, Revenue Cycle, Case Management, Legal, and Operations
• Strong knowledge of Centers for Medicare and Medicaid Services (CMS) guidance, regulations, policies, and direction from other government programs.
• Advanced proficiency within Microsoft 365.
• Ability to learn departmental and job-specific software programs.
• Excellent communication skills, both written and verbal that present clear and concise information.
• Superior ability to collect, analyze, and disseminate significant amounts of data with attention to detail and accuracy.
• Strong project management skills with the ability to manage multiple priorities simultaneously.

Responsibilities

• Provides compliance program support with audits and monitoring, corrective action plan management, data analytics, and other projects to ensure proper execution of the compliance program work plan and priorities.
• Performs audits to ensure that the clinical documentation contained within the patient chart supports items and services included on claims and accurately supports reasons for treatment, billing, payment, and operations.
• Performs clinical review audits to validate compliance with regulatory requirements such as Emergency Medical Treatment Labor Act (EMTALA), Discharge Planning, and Quality.
• Provides independent evaluations and assists with the maintenance of operational controls, tools, policies, and procedures.
• Conducts regulatory research to identify gaps and provides interpretation of clinical requirements and regulations to ensure appropriate application of medical and clinical criteria.
• Remains abreast of current developments in compliance.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees