Nurse AuditorRev Intgty

Chesapeake Regional Healthcare•Chesapeake, VA

42d

About The Position

The Nurse Auditor will coordinate, supervise, and respond to third-party patient bill audits. They will also perform patient-requested audits and random quality audits as schedule permits. This role acts as a resource for all hospital departments regarding charging questions and issues, and routinely reviews inpatient and outpatient records for appropriate coding and charging. The Nurse Auditor will provide educational sessions for revenue-producing departments on the appropriate charging process and procedures, and work cooperatively with Patient Accounting staff and other healthcare professionals to obtain correct HCPCS codes and modifiers. Additionally, they will assist the Health Information Department with RAC requests, coding reviews, and denials, ensuring the accuracy and integrity of charge data prior to billing interface and claims submission. The position requires the use of a computerized encoding system for accurate coding and sequencing of diagnoses and procedures according to established guidelines. The Nurse Auditor will report trends and improvements to the Director of Patient Accounts and will receive, review, verify, and process various chart audit requests. They will prepare written reports for finance and claims departments, educate staff on audit outcomes, and provide feedback and process improvement recommendations. The role also involves providing written explanations to patients questioning their bills and maintaining established productivity and accuracy requirements.

Requirements

Graduate of an approved school of professional Nursing.
Senior Level Coding experience of at least five years recent experience coding in an acute hospital setting required, with coding ability demonstrated via a skills assessment or five years of experience as an intensive care unit, emergency department or documentation specialist nurse auditor.
Experience with health information systems and computer technology required.
Ability to communicate effectively, both verbally and written format.
Must be able to work independently with attention to detail and accuracy.
Current Virginia RN License.
Familiar with coding diagnostic and procedural information from the record using ICD-10-CM and CPT-4/HCPCS classification systems.
Utilize a computerized encoding system to facilitate accurate coding.
Sequence diagnoses and procedures by following the ICD-10-CM, Uniform Hospital Data Set, Medicare, Medicaid, and other fiscal intermediary guidelines.

Nice To Haves

Bachelor of Science in Nursing preferred

Responsibilities

Coordinate, supervise, and respond to third party patient bill audits.
Perform patient requested audits in a timely manner.
Perform random quality audits as schedule permits.
Assist Patient Account personnel with patient questions about itemized charges.
Maintain reporting system of audit activities and identifies pattern and trending of results.
Act as resource for all hospital departments with charging questions and issues.
Routinely review inpatient and outpatient records for appropriate coding and charging.
Provide educational sessions for revenue producing departments regarding appropriate charging process and procedures.
Work cooperatively with the Patient Accounting staff and other health care professionals in obtaining correct HCPCS codes and modifiers.
Assist the Health Information Department with RAC requests, coding reviews, and denials.
Ensure accuracy and integrity of charge data prior to billing interface and claims submission.
Utilize a computerized encoding system to facilitate accurate coding; and sequence diagnoses and procedures by following the ICD-10-CM, Uniform Hospital Data Set, Medicare, Medicaid, and other fiscal intermediary guidelines.
Report trends and improvements to the Director of Patient Accounts regarding assigned HCPC codes and modifiers.
Receive, review, verify, and process requests for chart audits of inpatient hospitalizations, diagnostic testing, outpatient procedures and services, home health care services, durable medical equipment, rehabilitative therapies, and pharmacy reviews from finance and/or claims department.
Prepare written reports for finance and claims departments including explanations for recovery of money and appropriate regulatory agencies.
Educates provider services, claims, recovery, finance and other department staff on the outcomes of the audit results and assists provider services with educational efforts.
Provide feedback and process improvement recommendations to appropriate hospital departments and committees based on analysis and trending of hospital or provider audits.
Provide written explanations to patients who are questioning their bills.
Consistently maintain established productivity requirements and maintain a 96% or greater accuracy rate.
Attend hospital-wide orientation, in-services, educational meetings, and other meetings as required.
Attend other continuing education functions as necessary to maintain credentials, regardless of whether the educational programs are supported by the Department budget.
Exhibit excellent customer relations to patients, visitors, physicians, and co-workers.
Show courtesy, compassion, honesty, and respect to others in the adherence to the Hospital's mission, philosophy, and policy for promoting a positive work and customer environment.
Adhere to CRMC's confidentiality policy for all information related to patients, family and friends, hospital employees, physicians and clients.
Maintains effective interdepartmental communication.
Attend required hospital-wide orientations, meetings, and in-services.