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Revenue Cycle Compliance Auditor , RN

Company: Driscoll Children's Hospital
Location: Corpus Christi
Posted on: January 16, 2022

Job Description:

General Purpose of Job:From a clinical perspective, manage and supervise the activities relating to Revenue Cycle Charge Audits. Additionally, the Revenue Cycle Compliance Auditor, RN will be responsible for reviewing, disputing, and/or recommending course for denial accounts that are clinical in nature. From an education and training perspective, this team member will provide training to appropriate personnel, or departments, based on findings, on an as needed basis. This position would help assure Driscoll's Health System billing regulatory compliance through applied research, and communicate changes to appropriate stakeholders on any anticipated reimbursement changes.Essential Duties and Responsibilities:To perform this job successfully, an individual must have, a minimum clinical credential of RN, and be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employee will perform other reasonably related business duties as assigned by the immediate supervisor and/or health system administration as required.

  • Maintain utmost level of confidentiality at all times.
  • Adhere to health system policies and procedures.
  • Demonstrate business practices and personal actions that are ethical, and adhere to corporate compliance and integrity guidelines.
  • Assist in analysis and interpretation of rules and regulations, and ensure data is in the format required for reporting purposes.
  • Responsible for timely research and evaluation of Medicaid laws and changes to be incorporated in the departments, and/or organization's policies and procedures to apply appropriate reimbursement.
  • Gather, prepare and ensure timely submission of various state joint annual reports and/or compliance reporting.
  • Manage the (internal/external) communication and submission of regulatory charge audits.
  • Manage the (internal/external) communication and submission of account denials with a clinical rationale.
  • Effectively communicate with applicable stakeholders across the organization on discovered audit or denial trends.
  • Conducts and coordinates external audits with insurance company representatives, these duties could include but are not limited to:
  • Assists external auditors as they examine the requested medical record
  • Conducts exit conference with external auditor
  • Attends meeting involving billing internal and external auditing procedures and information
  • Contacts external auditors if there are any discoveries or discrepancies in audit outcomes
  • Reports audit status to Corporate Ethics and Compliance per scheduled basis
  • Reports clinical findings to DCH Case Management Director
  • Reports outcomes to DCH Patient Financial Services for accurate adjustments to patient bill as necessary
  • Prepare an audit summary report and conducts reimbursement follow up as it pertains to the audit
  • Coordinates schedule with external auditor, examines patient bills, and medical records to determine that billed services were rendered and that rendered services were billed correctly
  • Act as a key facilitator in education of other departments and facilities regarding government compliance, Medicare laws and reimbursement issues.
  • Prepare analytical reports on trends in health care reimbursement services, and advise on these sources, such as insurance and third party fund sources.
  • Assist in the analysis of proposed or new changes in legislation that would affect health system funding and operating service lines.
  • Provides education and training to clinical staff on audit findings.
  • Assist in the performance of special reviews at the request of Revenue Cycle Support Services Director.Education and/or Experience:
    • Bachelor's degree in Science in Nursing, Reqiored
    • Master's in Business Management or Accounting, preferred
    • Proficiency in Microsoft Excel, PowerPoint and Word
    • Prior experience with EPIC, 3M, ICD-10 or Midas is a plus
    • 7+ years of experience in a hospital or healthcare setting w/clinical knowledge preferred
    • Strong oral and written communication skills
    • Strong organizational skills
    • Ability to multi-task and work on multiple projects simultaneously
      Classification:Full-time Regular (72+ hrs/pp)Work Schedule:Days

Keywords: Driscoll Children's Hospital, Corpus Christi , Revenue Cycle Compliance Auditor , RN, Accounting, Auditing , Corpus Christi, Texas

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