RN Nurse Auditor- Patient Financial Services FT

POSITION SUMMARY

Responsible for the completion of chart audits compared to patient accounts to ensure billing accuracy as mandated by regulations. Audits may be requested or concurrent and reported on a monthly basis. Act as a resource when questionable diagnosis and/or procedures need clarification based on medical necessity and appropriateness. Interact with patients to resolve disputed claims. Completes daily charge rejection report. Assist with root cause analysis when errors and trends are noted. Continuous education provided to ancillary departments.

POSITION REQUIREMENTS

Minimum Education: None

Minimum Work Experience: Minimum of two years' experience in medical and/or surgical nursing required.

Required Licenses/Certifications: Texas licensed as Registered Nurse.

Required Skills, Knowledge, and Abilities: Ability to interpret and generate written correspondence utilizing proper grammar, spelling, and composition skills. Computer knowledge required. Experience with automated systems required. Ability to operate office equipment, such as copy machines, fax machine and printers. Must be able to work independently with minimal supervision. Good verbal and written communication skills essential. Prior experience involving public

contact.

Preferred Qualification: Good understanding of patient accounting and medical charting preferred.

Good understanding of patient accounting and medical charting preferred.

JOB SPECIFIC FUNCTIONS

• Reinforces HMHD's values and promotes HMHD's Compliance Plan and understanding of applicable laws and standards.
• Demonstrates proficiency in understanding the materials presented during the corporate integrity and compliance training and education program.
• Attends the required corporate integrity and compliance training and education programs.
• Ensures department employees attended (in a timely manner) the compliance training in accordance with HMHD policies.
• Assists the Compliance Officer and the Executive Compliance Committee in identifying "high risk" issues within his/her department.
• Complies with all HIPAA standards.
• Address and return account inquiries within 24 hours.
• Performs audits of patient bills compared to the medical records for accuracy upon request. Complete random billing audits.
• Monitors over & under charges due to charge capture errors.
• Identify departments that fail to adequately document charges and/or have a high occurrence of late charges.
• Provide lines of communication to management to resolve charge capture issues and minimize lost revenue.
• Assist when charge capture concerns are expressed.
• Severs as charge capture staff and performs concurrent audits for designated departments.
• Completes research and troubleshooting as needed.
• Assist with root cause analysis when errors and trends are noted.
• Complete Monthly Audit Results Report summarizing project status, challenges and successes of accounts audited and present to Manager, Director or appropriate Denial and PI Committees when requested.
• Assist to provide continuous education to ancillary departments.
• Resolve issues and/or concerns amicably in a timely manner.
• Involves PFS Leader when needed.
• Take corrective action to resolve charge errors (i.e. corrections, data extraction, education).
• Serve as a resource for others within the District.
• Assist manager, director and CFO upon request.
• Work within multiple systems (i.e. contract management software, HIS, scanning, etc.) while meeting production, financial, and quality goals.
• Enter accurate and thorough comments on each patient account.
• Promote and demonstrate excellent customer service at all times with internal and external customers to include patients, physicians, co-workers and all other customers.
• Communicates effectively and expresses ideas clearly, actively listens and follows appropriate channels of communication.
• Adaptable and responsive to change.
• Uses time clock accurately and is punctual on a consistent basis.
• Demonstrates a positive attitude in all assigned task and towards others.
• Follows "Call-In" policy by notifying PFS Leader of absence.
• Absences during evaluation period: 0-6 Occurrences = Meets Requirements. 7 or more Occurrences = Does not meet requirements.
• Adheres to hospital and department dress code. Maintains a professional appearance at all times.
• Consistently contributes to the achievement of excellence in healthcare through the quality and caring values of the mission and vision of Hunt Memorial Hospital District.
• Perform special duties and projects as assigned.