RN Clinical Audit Management Analyst

Sanford Health • Bismarck, ND

2d • $24 - $39 • Remote

About The Position

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We’re proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint. Keeps audit activity current, moving and prevent the organization from having unnecessary financial burden for the audit process. Participates and consults with internal experts to determine response on complex cases and coordinates the appeal process. Works closely with physician advisor, software vendor or other external resources associated with this initiative. Works with internal experts on prevention strategies. Working knowledge of rules and regulations as they pertain to Centers for Medicare and Medicaid Services (CMS)' government programs and non-government regulatory and enforcement agency audits for documentation and billing compliance. Knowledge of Inpatient Prospective Payment system and Outpatient Prospective Payment system required. A basic understanding of multiple reimbursement models such as, but not limited to, Medicare Severity Diagnosis Related Groups (MS-DRGs), Ambulatory Payment Classification (APC)'s and fee for service. Must have strong communication, computer, and analytic skills; must also have strong attention to detail, ability to use independent discretion, and ability to prioritize to meet deadlines.

Requirements

• Bachelor's Degree in health-related field. In lieu of degree, will consider minimum six years equivalent work experience.
• Must have strong communication, computer, and analytic skills; must also have strong attention to detail, ability to use independent discretion, and ability to prioritize to meet deadlines.
• Knowledge of Inpatient Prospective Payment system and Outpatient Prospective Payment system required.
• A basic understanding of multiple reimbursement models such as, but not limited to, Medicare Severity Diagnosis Related Groups (MS-DRGs), Ambulatory Payment Classification (APC)'s and fee for service.

Nice To Haves

• Prefer an education/knowledge acquired through an accredited school of nursing.
• Registered Nurse (RN) license preferred, coding certification preferred.
• If possession of an RN license, hold an unencumbered RN license with the State Board of Nursing where the practice of nursing is occurring and/or possess multistate licensure if in a Nurse Licensure Compact (NLC) state.
• Obtains and subsequently maintains required department specific competencies and certifications.

Responsibilities

• Responsible for the oversight and coordination of payer audit requests, audit progress, case determinations, appeals and audit resolution within COBIUS audit database.
• Functions as the primary audit liaison for case management, medical advisors, clinical and operational departments and patient financial services for all of Sanford.
• Keeps audit activity current, moving and prevent the organization from having unnecessary financial burden for the audit process.
• Participates and consults with internal experts to determine response on complex cases and coordinates the appeal process.
• Works closely with physician advisor, software vendor or other external resources associated with this initiative.
• Works with internal experts on prevention strategies.
• Working knowledge of rules and regulations as they pertain to Centers for Medicare and Medicaid Services (CMS)' government programs and non-government regulatory and enforcement agency audits for documentation and billing compliance.

What This Job Offers

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