AdventHealth West Fl Division
Registered Nurse
Submission for the position: Nurse Auditor - (Job Number: 22032717)
https://adventist.taleo.net/careersection/jobdetail.ftl?job=22032717&lang=en
Nurse Auditor
All the benefits and perks you need for you and your family:
• Benefits from Day One
• Paid Days Off from Day One
• Student Loan Repayment Program
• Career Development
• Whole Person Wellbeing Resources
• Mental Health Resources and Support
Our promise to you:
Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.
Schedule: Full Time
Shift : Day Shift
Location: 3100 East Fletcher Avenue Tampa, Florida 33613
The community you’ll be caring for:
• AdventHealth Pepin Heart Institute, known across the country for its advances in cardiovascular disease prevention, diagnosis, treatment and research.
• Surgical Pioneers – the first in Tampa with the latest robotics in spine surgery
• Building a brand new, six story surgical and patient care tower which will ensure state of the art medical and surgical car for generations to come
• Awarded the Get With The Guidelines – Stroke GOLD Quality Achievement Award from the American Heart Association/American Stroke Association and have been recognized as a recipient of their Target: Stroke Honor Roll for our expertise in stroke care. We have also received certification by The Joint Commission in collaboration with the American Stroke Association as a Primary Stroke Center.
The role you’ll contribute:
The Nurse Auditor will ensure that the charges that are generated in the Cerner Clinical system are being properly billed. This will be accomplished by conducting chart audits that compare charges with physician orders, clinical documentation and reports. The Nurse Auditor will work closely with Financial Services and the Patient Accounting departments to review and correct any charge errors that they find. Complex charge issues that require research may be referred to this position by HIM, PFS, Customer Service or case management. The Nurse Auditor will work closely with the FH/Managed Care department anytime there are audits requested by an insurance company. This position will be responsible for participating in and occasionally chair meetings that address process improvement initiatives related to charge accuracy levels. Responsible for auditing multiple operational areas. Provides regional coverage as required to Tampa, Helen Ellis, Carrollwood, LTAC, Dade City, Ocala and Wesley Chapel.
The value you’ll bring to the team:
• Assist FH/Managed Care Department when outside agencies conduct audits involving hospital billing.
• Work closely with FH/Managed Care department when outside agencies request chart audits.
• When customer service complaints related to charges are received conducts research into the legitimacy of the charge
• Logs price and billing complaints and reports results to supervisor.
• Works closely with PFS/HIM/Finance to research and correct specific problem accounts or areas.
• Certain charge issues that appear on the interface rejection report, SSI edits or coding software will be referred to the nurse auditor for research and possible correction.
• When charge errors require correction by the department who generated the original charge; completes the standard error correction worksheet developed by HIM & PFS for this purpose.
• May conduct ongoing departmental charge audits that are focused on checking for specific charge problem areas i.e. procedure billing of observation accounts.
• Monitors charge accuracy levels for all revenue producing departments.
• Conducts charge audits checking physician orders, clinical documentation and reports against billed charges.
• Provides revenue producing departments with a report of their charge accuracy levels.
• Makes process improvement recommendations to departments that have been audited.
• When requested, leads out in charge accuracy improvement meetings that address specific process and charge issues.
• Charge questions that are raised by departments will be researched with the involvement of the corporate CDM/HIM/PFS departments to ensure that the issue is addressed by the proper individuals at the corporate office.
• Utilizes the corporate charge master manual as a guide for determining the proper charge
The expertise and experiences you’ll need to succeed:
• Ability to interact with the Hospital Financial Department, HIM personnel, and departmental leaders.
• Knowledge of the disease process and treatment methodology is required and utilized at least 50% of the time.
• Knowledge of ICD-9 and CPT Coding Principles as well as billing methodologies. Knowledge of computer system includes Windows, Excel, Cerner Clinical and Series billing systems. Ability to communicate effectively in writing and verbally. Must have financial analysis capabilities.
• Occasional contact with patients and outsiders. Regular contact with employees.
• The Nurse Auditor has access to institutional financial goals and ongoing reports supporting the achievement and benchmarks of the Finance Committee. The Nurse Auditor utilizes those goals to create reports from both Medical Records and financial systems. The Nurse Auditor has the responsibility to adhere to the Florida Hospital Corporate Compliance plan, to the rules and regulations of all local, state, and Federal agencies, and to the standards of all accrediting bodies.
• Must be able to cover in absence of a Clinical Auditor
• Must be adaptable and flexible as required
• Regional Travel up to 20% required
• RN with current Florida license
• 3 years clinical hospital experience, CDM management, case management or order entry maintenance experience.
• Knowledge of the disease process and treatment methodology is required and utilized at least 50% of the time.
• BSN (preferred)
• 3 years of auditing experience either for hospitals or insurance companies preferred.
Quality/Clinical Effectiveness
AdventHealth Tampa
US-FL-Tampa
ADVENTHEALTH TAMPA (TP01000000)
3100 E FLETCHER AVE
Tampa , 33613
ADVENTHEALTH TAMPA
3100 E FLETCHER AVE
Individual Contributor
Yes, 25 % of the Time
Sep 8, 2022, 3:52:19 PM
Schedule: Full-time Location(s): US-FL-Tampa Day Job Job Level: Individual Contributor Travel: Yes, 25 % of the Time