RN CLINICAL COMPLIANCE ADVISOR- FT

Job Description

Ready to love where you work? The Hospital Authority of Miller County includes Miller County Hospital, Miller Nursing Home, Calhoun Nursing Home and other organizations that utilize clinical and non-clinical skillsets.

Position Summary:

The RN Clinical Compliance Advisor is responsible for supporting various quality payment program requirements. The RN Compliance Advisor works closely with the Quality Payment Program and Compliance Program to provide support to HAMC medical facilities. Performs clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which an appeal has been submitted, to ensure medical necessity and appropriate/accurate billing and claims processing. The RN Compliance Advisor is to apply advanced clinical knowledge upon evaluation of medical claims and associated records. The RN Compliance Advisor needs a thorough understanding of all relevant and applicable federal and state regulatory requirements and guidelines, knowledge of HAMC policies and procedures, and individual judgment and experience to assess the appropriateness of service provided, length of stay and level of care.

This position plays a key role in improving performance of a business unit or functional process through internal auditing and monitoring, analysis of current state (performance and root causes), and development of improved or new functions, processes, and/or tools to optimize outcomes, integrating industry best practices and/or innovations into HAMC. The RN Compliance Advisor works with Quality, HIM, and Compliance teams to ensure that HAMC clinical operations is compliant with regulatory requirements and to build a strong performance monitoring and audit readiness program.

Requirements:

Active GA RN license

We celebrate individual and team achievements, offer a supportive family work atmosphere, and encourage every individual to learn, grow, and move into new positions in our organizations. If you are ready to Discover Extraordinary, it is time for you to Discover Miller!