RN Nurse Auditor

Eisenhower Health•Rancho Mirage, CA

30d•$48 - $78•Onsite

About The Position

Responsible for concurrent audits of Medical Record Chart for verification of consistent demographic data and completeness of clinical documentation. Responsible for pre-auditing medical records for all accounts scheduled for audits by insurance companies, external audit agencies and/or patient requested audits. Responsible for instituting and leading Process Improvement Teams to record, quantify and correct deficiencies. Represents PFS to share audit finding with exiting Hospital Chart Audit Committee and Hospital Compliance Officer and Committee.

Requirements

Experienced Medical Auditor
Knowledge of Medical Records and coding
California RN Licensure
Effective computer knowledge of MS Word, Excel and database applications
Excellent verbal and written communication skills; ability to make executive presentations
Experience with Hospital cost center charging practices
knowledge of hospital billing and database systems
Familiar with billing and medical records compliance issues as mandated through Federal regulations
Must understand commercial and managed care patient accounting principals
Proficient understanding of medical terminology, managed care terminology, and CPT/ICD9 coding

Nice To Haves

Prior Customer Service

Responsibilities

Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.
Coordinates medical record audit scheduling with external auditors, medical records and ancillary departments when necessary
Meets with external auditors during schedule audits and assists as needed
Conducts exit conference with external auditors
Reports to Compliance Officer and Compliance Committee any patterns seen relative to poor documentation or charting.
Reports any charging issues that do not conform to current Federal Regulations governing billable/non-billable charges
Prepares reports on Monthly basis showing: Total Patient/defense and concurrent audits for month with: Total gross charges, over charges/under charges by department, defense results, and final determination, Summary of deficiencies found in medical record charts to include the following: Itemization of issue Current status on correction activities,
Attends available seminars pertaining to compliance Issues and guidelines, Medical and Billable Coding and Medical Record Charting
Provides positive indication that teamwork is a major and important focus of all Eisenhower Medical Center employees.
Conducts periodic in-service classes for ancillary departments instructing the staff on charge/chart review
Conducts periodic in-service classes for Patient Financial Services department instructing the staff on common medical terms and errors in charging.
Performs other job related duties as requested by Supervisor
Attends staff meeting, in-house training and attends classes pertaining to Federal and State billing regulations as well as Compliance Issues and Guidelines when requested