Navigant Nurse Auditor in Lewisville, Texas
Location: Lewisville, TX
Job Code: 1643
The Nurse Auditor is responsible for monitoring, evaluating and facilitating the revenue collection and clinical documentation process associated with revenue capture within the hospital setting.
The Nurse Auditor organizes audits of claims to ensure compliant billing, identifies lost charges and coordinates charge capture within timeliness standards, independently audits HIM coding for Medicare and third-party-payer compliance.
This position assists in reimbursement analysis for financial outcomes affecting all areas of hospital charge capture operations and will perform any and all job related duties as assigned.
Essential Job Functions
Ability to Review Medical Records
Ensure Documentation Integrity
Working Knowledge of provider billing
Guidelines and related industry base standards
Utilize e-Web coding
Strong and prior experience in auditing in a provider or payer environment
Duties and Responsibilities
Audits clinical documentation of complications and co-morbidities to support accurate DRG coding.
Defends against third party payers and patient charge audits.
Ensures that charges are thoroughly and accurately captured in a compliant manner.
Conducts concurrent charge capture audits on a sample basis for all revenue producing departments.
Logs and tracks late charges, over/under charges by departments based on monthly sample audits and reviews with appropriate departments to insure timely charge capture.
Assist charge posting departments in the creation and administration of charge posting practices.
Chair and staff monthly Chart Audit Committee to review audit findings and issues and resolutions.
Assist with RAC audit coordination.
Develops policies and procedures for audit program insuring that audit procedures are maintained and adhered to.
Assist departments with establishing daily charge reconciliation process.
Provide in services to education and create financial awareness throughout the organization.
Provide strategic information to support administration and senior management in reimbursement and compliance.
Maintain technical proficiency and remain current with the latest developments, advancements and trends in billing and coding compliance.
Ability to effectively communicate with departmental staff, physicians, and other hospital departments.
Knowledge of computer applications in healthcare including EMR and Order Entry systems.
Able to translate clinical procedures, services and supplies into applicable CDM/CPT charge capture process.
Maintain current knowledge of basis Coding Clinic Guidelines, requirements necessitating Medical Necessity for patient hospitalization, capture of Severity of Illness/Intensity of Service and Risk of Mortality data elements per self-instruction and or structured continuing education classes.
Ability to compile MR review elements into a working spreadsheet and or written presentation for client facility or Navigant Cymetrix staff.
May be required to present oral presentations to client facility or Navigant Cymetrix staff.
Education /Qualifications /Experience
Current Registered Nurse licensure
Minimum of 5 years clinical experience preferred in acute hospital setting.
Health Information Management degree with current accreditation or registration from the American Health Information Management Association (RHIA) or any equivalent combination of education and experience which provides the knowledge and skills to perform the job.
Experience and knowledge of all aspects of diagnostic and procedure coding and Medicare reimbursement to include DRG’s, AP-DRG’s, ICD-10 and CPT coding, and APG/APC encoding and grouping methodologies.
Knowledge of clinical and financial decision support systems, particularly service-line inpatient and outpatient oriented systems with use of database tools, including Microsoft Attention to detail, strong organizational skills and self-motivated.
Ability to work under a timeline/deadline & provide clear & accurate updates to project leader of assignment progress, hours worked & expected outcomes on a daily basis.
Familiarity with medical records assembly & clinical terminology, coding terminology additionally beneficial.
Physical and Mental requirements:
Constantly operates a computer and other office equipment to coordinate work
Usually remains stationary for the majority of the day
Frequently communicates with clients and coworkers and must be able to share information effectively
Occasional stooping, reaching or kneeling may be necessary to reach into overhead or low cabinets
Regularly uses close visual acuity and operates computer equipment to prepare and analyze and transmit data
Generally works in an office environment
Navigant Cymetrix is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information or any other basis protected by law, ordinance, or regulation.