Temp - Registered Nurse (RN) - Compliance Auditor (Days) Dallas, TX
Description:
Title: Temp - Registered Nurse (RN) - Compliance Auditor (Days) Dallas, TX
Description: Candidates living within 60 miles of the facility will have a local rate of ***
The Compliance Nurse Auditor is responsible for
conducting audits to ensure the clinical
documentation contained within the patient medical
record supports the reasons for treatment, coding/billing, payment or
operations. Audits are designed to ensure accuracy
of content and compliance with clinical best practice,
system policies and procedures and applicable regulatory requirements and payor
rules. The Nurse Auditor provides reports of findings, including
recommendations to improve documentation, coding or billing practices, correct
discrepancies discovered and implement corrective action to prevent reoccurrence.
Skills or Special
Abilities:
Advanced computer
skills and proficient with Microsoft Office
applications.
Detailed knowledge
of compliance program
requirements for hospitals
and academic health systems.
Demonstrates
the ability to evaluate healthcare compliance issues and make appropriate
recommendations. Special focus on compliance matters involving quality
of care, patient
safety, utilization management, medical necessity and evidence-based
guidelines.
Demonstrates the ability to accurately and timely audit and reconcile patient medical records
and financial accounts.Strong
oral and written communication skills and interpersonal skills. Able to
communicate thoughts, ideas, information and messages with clear language,
style, organization and format
appropriate to the subject matter, purpose and audience.
Possesses excellent critical thinking skills,
including the ability
to identify a problem, determine
the root-cause, communicate findings and participate in the development
of the solution.
Detail-oriented with strong organizational and time management skills and the ability to effectively prioritize daily tasks.
Capable of managing difficult
conversations with sensitivity and the ability
to respond to confidential information with
objectivity and discretion.
Demonstrates a high degree of integrity and practice ethical
standards.
Responsibilities
Conducts audits of patient
medical records to ascertain whether the care provided is properly documented
in support of clinical best practice(s) and evidence-based guidelines and
accurately reflects the items
and services included
in the financial account (i.e.,
on the bill or claim).
Provides detailed reports and develops corrective action plans to correct discrepancies identified during theaudit process.
Explicitly and concisely document
clinical and charge-audit findings in a way that can be easily
understood by non-clinical personnel.
With
a focus on quality of care, patient safety and appropriate revenue integrity
practices, conducts routine monitoring in an effort to prevent, detect and
respond appropriately to compliance risks. Consults
with management to report findings
and provide corrective action recommendations.
Conducts thorough
research and provides
prompt, courteous consultative services regarding
compliance matters.
Assists in monitoring and responding to audits and/or inquiries from government agencies
and their contractors.
Provides clinical
knowledge as needed to help the department determine whether to make
refunds/repayments to Federal healthcare programs.
Assists with the development of new, or revisions of, existing policies
and procedures, as warranted, based upon regulatory developments and compliance monitoring and auditing activities/findings.
Monitors changes
in laws and regulations related
to compliance and communicates changes
to appropriate personnel.
Collaborates with personnel
across Parkland particularly in the Internal
Audit, Patient Financial Services, Health Information
Management, Care Management, Government Reimbursement, Regulatory and
Accreditation, Clinical Research, Clinical Support Services, and Legal
Departments, and with representatives of UT Southwestern.