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Sr., Compliance Nurse Auditor - Clinical

Date:  Nov 10, 2021
Location: 

Dallas, TX, US

Category:  Clerical and Administrative Jobs
Job Type:  Day
Requisition ID:  568461

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.

Primary Purpose
The Compliance Nurse Auditor is responsible for conducting audits to ensure the clinical documentation contained within the patient medical record supports the reasons for treatment, coding/billing, payment or operations. Audits are designed to ensure accuracy of content and compliance with clinical best practice, system policies and procedures and applicable regulatory requirements and payor rules. The Nurse Auditor provides reports of findings, including recommendations to improve documentation, coding or billing practices, correct discrepancies discovered and implement corrective action to prevent reoccurrence.

 

Minimum Specifications
 

Education

  • Must have a bachelor’s degree; preferably in a clinical or healthcare-related field.

 

Experience
Must have 6 years of progressively responsible experience in a healthcare related clinical, administrative, financial, or compliance role.

Prior experience conducting clinical quality or utilization reviews or compliance audits involving federal healthcare programs such as Medicare and Medicaid is preferred.
Prior experience in coding, revenue cycle, Charge Description Master (CDM) or revenue integrity is preferred.
 

Equivalent Education and/or Experience

  • An equivalent combination of experience, current nursing license and compliance certification may be accepted in lieu of education only.

 

Certification/Registration/Licensure

  • Must have a valid and unrestricted RN license or temporary license from the Texas Board of Nursing or valid Compact RN license.

Certification in a healthcare compliance-related specialty is required. Must be currently certified and in good standing with one of the following or obtain within 18 months of placement in position:

  • Certified in Healthcare Compliance (CHC)
  • Certified Compliance and Ethics Professional (CCEP)
  • Certified in Healthcare Privacy Compliance (CHPC)
  • Certified in Healthcare Research Compliance (CHRC)
  • Certified Professional Compliance Officer (CPCO)
  • Certified Professional Coder (CPC)
  • Certified Outpatient Coder (COC)
  • Certified Inpatient Coder (CIC)
  • Certified Coding Specialist (CCS)
     

Required Tests for Placement
 

Skills or Special Abilities

  • Advanced computer skills and proficient with Microsoft Office applications.
  • Detailed knowledge of compliance program requirements for hospitals and academic health systems.
  • Demonstrates the ability to evaluate healthcare compliance issues and make appropriate recommendations. Special focus on compliance matters involving quality of care, patient safety, utilization management, medical necessity and evidence-based guidelines.
  • Demonstrates the ability to accurately and timely audit and reconcile patient medical records and financial accounts.
  • Strong oral and written communication skills and interpersonal skills. Able to communicate thoughts, ideas, information and messages with clear language, style, organization and format appropriate to the subject matter, purpose and audience.
  • Possesses excellent critical thinking skills, including the ability to identify a problem, determine the root-cause, communicate findings and participate in the development of the solution.
  • Detailed-oriented with strong organizational and time management skills and the ability to effectively prioritize daily tasks.
  • Capable of managing difficult conversations with sensitivity and the ability to respond to confidential information with objectivity and discretion.
  • Demonstrates a high degree of integrity and practice ethical standards.


 

Responsibilities

  1. Conducts audits of patient medical records to ascertain whether the care provided is properly documented in support of clinical best practice(s) and evidence-based guidelines and accurately reflects the items and services included in the financial account (i.e., on the bill or claim). Provides detailed reports and develops corrective action plans to correct discrepancies identified during the audit process.  
  2. Explicitly and concisely document clinical and charge-audit findings in a way that can be easily understood by non-clinical personnel.
  3. With a focus on quality of care, patient safety and appropriate revenue integrity practices, conducts routine monitoring in an effort to prevent, detect and respond appropriately to compliance risks. Consults with management to report findings and provide corrective action recommendations.
  4. Conducts thorough research and provides prompt, courteous consultative services regarding compliance matters.
  5. Assists in monitoring and responding to audits and/or inquiries from government agencies and their contractors.
  6. Provides clinical knowledge as needed to help the department determine whether to make refunds/repayments to Federal healthcare programs.
  7. Assists with the development of new, or revisions of, existing policies and procedures, as warranted, based upon regulatory developments and compliance monitoring and auditing activities/findings.
  8. Monitors changes in laws and regulations related to compliance and communicates changes to appropriate personnel.
  9. Collaborates with personnel across Parkland particularly in the Internal Audit, Patient Financial Services, Health Information Management, Care Management, Government Reimbursement, Regulatory and Accreditation, Clinical Research, Clinical Support Services, and Legal Departments, and with representatives of UT Southwestern.
     

Job Accountabilities

  • Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland.
  • Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
  • Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.


Nearest Major Market: Dallas
Nearest Secondary Market: Fort Worth

Job Segment: Clinic, Nursing, Medical, Clerical, Patient Care, Healthcare, Administrative