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CLINICAL NURSE AUDITOR

Company: The Methodist Hospitals
Location: Gary
Posted on: November 11, 2020

Job Description:

The Clinical Nurse Auditor will be responsible for medical chart auditing which will enhance charging accuracy and payments to the Hospital. Identifies whether charges have been entered that are not supported by documentation from appropriate sources, and review medical charts for charging accuracy. The Clinical Nurse Auditor will become knowledgeable about specific charging mechanism at this facility, and recommend improvements to charging processes and/or clinical documentation. Also responsible for identifying chargemaster/coding improvements, including payor specific requirements, to help improve Hospital recoveries.PRINCIPAL DUTIES AND RESPONSIBILITIES(*Essential Functions)

  • Assembles and reviews documents and various reports from Nursing and Ancillary departments.
  • Audits various documents to determine clinical procedures performed for the benefit of a patient, and whether the charges were appropriately entered on the Hospital's information system.
  • Researches for both over-charges and under-charges.
  • Provides information and makes recommendations to various Departments in order to enhance the Hospital's efforts to improve accuracy of patient specific charges and accounting procedures.
  • Communicates with departments to determine appropriate protocols and charges in various patient care situations.
  • Maintains departmental documentation of protocols and practices for internal and external reference.
  • Maintains manual and PC based audit logs and researches trends to determine appropriate corrective action.
  • Receives audit requests from internal and external sources including patients, physicians, insurance carriers, hospital departments or their authorized representatives.
  • Communicates audit outcomes with staff, patients and insurance and third-party auditors as may be deemed appropriate by Hospital policies and guidelines regarding confidentiality and release of medical information.
  • Researches, prepares, and provides price estimates for all patient inquiries.
  • Resolves conflicts with patients and hospital by explaining financial policies and/or payor regulations explaining itemized entries on the patient's account.
  • Serves as a resource to Financial Services staff in answering questions regarding charges, supplies, and nature of service.JOB SPECIFICATIONS(Minimum Requirements)
  • KNOWLEDGE, SKILLS, AND ABILITIES
  • Knowledge of various types of clinical treatment and procedures, medical terminology, coding, utilization review and quality assurance.
  • Working knowledge of revenue charge generation and flow of transactions from admissions, medical records and billing.
  • Excellent analytical skills.
  • Must have good verbal and written communication skills and be able to effectively and tactfully deal with the public, medical staff, peers employees and customers.
  • Must be proficient in computer systems, including knowledge of major hospital billing and coding database.
  • Ability to work with all levels of management effectively.
  • Must be self-motivated individual that can exercise a high level of independent actions, judgment and decision making.
  • Ability to work under stress and stressful conditions.EDUCATION
    • Associates Nursing Required
    • 5 Healthcare/Medical Required
    • Licensed Registered NurseSTANDARDS OF BEHAVIORMeets the Standards of Behavior as outlined in Personnel Policy and Procedure #1, Employee Relations Code.CONFIDENTIALITY/HIPAA/CORPORATE COMPLIANCEDemonstrates knowledge of procedures for protecting and maintaining security, confidentiality and integrity of employee, patient, family, organizational and other medical information. Understands and supports the commitment of Methodist Hospitals in adhering to federal, state and local laws, rules and regulations governing ethical business practices for healthcare providers.DISCLAIMER - The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. The statements are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required.

Keywords: The Methodist Hospitals, Gary , CLINICAL NURSE AUDITOR, Healthcare , Gary, Indiana

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