CLINICAL AUDITOR Nursing Hours: 8-430 Days - Full-time Paygrade/Wages/Salary Info: OH 2013-76 - 40403A
Job Summary Performs medical and revenue audits to ensure revenue integrity as related to adherence to federal and state regulations, policies of external payers, coding rules, and guidelines. Provides critical analytical and negotiation support with respect to third party payer reimbursement contracts. # Job Responsibilities Responsible for conducting quality control audits to ensure data/documentation integrity, communicating findings and recommendations, explaining regulatory requirements, and overseeing the corrective actions for audits within the operational units. Compiles information and/or prepares reports and analyses setting forth results of data integrity findings with appropriate recommendations; performs subsequent audits to ensure complete and appropriate corrective action has occurred. Follows up with appropriate staff members to ensure accurate and complete documentation in the medical record. Works collaboratively with the appropriate operational leaders to develop provider education strategies to promote complete and accurate clinical documentation and correct negative trends and is able to impart this knowledge to providers and other staff members. Conducts third party defense audits, concurrent audits, and complaint audits as required. Assists with responding to patients# inquiries concerning the accuracy of billed charges and charge descriptions. May assist with resolving third-party payer inquiries and billing disputes. Qualifications Associate#s degree or higher in Business required upon hire OR Associate#s degree or higher in Healthcare Administration required upon hire OR Associate#s degree or higher in Nursing required upon hire OR Associate#s degree or higher in related field required upon hire A combination of education, training and experience may be considered in lieu of degree. A minimum of 2 years# relevant experience required Specialty - Licensure/certification in clinical specialty required upon hire Skills and Attributes Requires critical thinking skills and decisive judgment. Works under general supervision. Must be able to work in a stressful environment and take appropriate action. Ability to exercise independent decisions using analytical and problem solving skills. Requires a strong understanding of the specialized concepts, practices, and procedures in the area of specialization. Physical Demands Standing: Occasionally Walking: Occasionally Sitting: Frequently Lifting 0-25 lbs: Rarely Lifting 25-75 lbs: Never Lifting over 75 lbs: Never Carrying 0-25 lbs: Rarely Carrying 25-75 lbs: Never Carrying over 75 lbs: Never Pushing/Pulling 0-25 lbs: Rarely Pushing/Pulling 25-75 lbs: Never Pushing/Pulling over 75 lbs: Never Climbing: Rarely Bending/Stooping: Rarely Kneeling: Rarely Crouching/Crawling: Rarely Reaching: Occasionally Talking: Frequently Hearing: Occasionally Repetitive Foot/Leg Movements: Never Repetitive Hand/Arm Movements: Frequently Keyboard Data Entry: Frequently Running: Never Vision: Depth Perception: Frequently Vision: Distinguish Color: Frequently Vision: Seeing Far: Frequently Vision: Seeing Near: Frequently Owensboro Health Core Commitments INTEGRITY - We conduct ourselves with a high level of responsibility, reliability and honesty because we take seriously the trust of our patients and coworkers. RESPECT - We value and accept the unique talents and contributions of every patient, customer and team member in the Owensboro Health community. TEAMWORK - We build a spirit of connectivity and fellowship by striving together to overcome obstacles, surpass goals, celebrate accomplishments and plan the future. INNOVATION - We foster original ideas and creative solutions that improve our daily work and promote the mission of Owensboro Health. SERVICE - We focus on service to patients, customers and team members by anticipating their needs, thoughtfully meeting those needs and continually improving the quality of everything we do. EXCELLENCE - We reach beyond basic expectations to expand our knowledge and awareness, produce exceptional work and provide outstanding service.