Lead, Clinical Charge Auditor, RN

Industry: Service - Charge Audit Job Number: 2922

Job Description

Lead, Clinical Charge Audit - RN

The Lead, Clinical Charge Audit - RN will work in conjunction with the Director of Clinical Charge Audit to oversee the various functions of the Clinical Charge Audit Department for Managed Resources, Inc.

The Lead, Clinical Charge Audit's responsibilities include review of audits according to established company parameters, assisting with quarterly reports for clients and attending meetings as needed with clients and audit team members, maintaining a work queue of assignments, and other duties as needed if Director is unavailable.

  • Oversee the day-to-day functions of the Clinical Charge auditors including timeframes, assignments, providing audit guidance related to regulations and charge policies, and quality assurance.
  • Serve as client liaison for audit clients including assistance with reporting of audit results and improvement strategies.
  • Subject matter expert for Clinical Charge Audit questions from Nurses and Clients.

Essential Job Functions: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Complete the following functions in accordance with Managed Resources policies:
  • Assists in the management of the Clinical Charge Audit team including training, daily oversight of audit projects, quality assurance and ongoing review of performance.
  • Performs concurrent and retrospective audits for MRI client base utilizing CMS guidelines, insurance contracts, charge policies and charge-master.
  • Maintains daily contact with auditors to ensure high quality reviews.
  • Reviews, researches, and responds to auditors’ questions regarding audit issues and EMR.
  • Assists in compiling and communicating findings both written and verbally to enhance compliance and revenue recovery for the client.
  • Maintains a meaningful and respectful relationship with the client.
  • Monitors audit team progress in meeting the goals identified in the contracts for defense, charge, and compliance reviews.
  • Educates Nurse Auditors regarding audit standards, charge policy changes, client contacts, insurance contracts and regulations pertaining to the client’s audit process.
  • Assists audit staff to correctly interpret account charges, the medical record and client charge practices.
  • Performs high quality audits and appeals while gathering charge data to report to client.
  • Provides periodic quality assurance reviews and training for audit team.
  • Monitors audits for errors and collaborates with audit director regarding improvement plans.
  • Assist auditors with defense audits/appeals by performing research of publications, regulations, and insurance contracts.
  • Acts as a role model by conducting audits in an ethical manner based on findings in the clinical documentation and representing the best interest of the client when possible.
  • Assists with payroll functions, staff evaluation and staffing.
  • Ensure employee compliance with HIPAA regulations/training as required.
  • Provides input on content and direction of team meetings. Clients
  • Performs Quality Assurance on an ongoing basis to provide accurate data to clients.
  • Monitors and intervenes to ensure timely completion of audits according to client specification.
  • Review and respond to client requests or identified issues.
  • Participate in hospital meetings as requested to report audit findings and suggest improvements in charge practices and processes.
  • Provides educational services to improve revenue recovery and compliance. • Travels to client sites for meetings and educational presentations on an occasional basis.
  • Communicate effectively with audit staff, project principals, and MRI administrative staff.
  • Performs activities as requested by MRI including composing of reports and presentations, and revision of job descriptions. Ideal candidate will possess the following:
  • Registered Nurse with previous management experience preferred; BSN preferred.
  • Strong skills including analytical, verbal communication, written communication, customer service, time and project management, and leadership.
  • Leadership skills to include organizing a meeting, completing performance evaluations, ability to present Power Point demonstrations to clients.
  • Certified Clinical Financial Auditor a plus.
  • Possesses knowledge and experience with regulations related to inpatient and outpatient charges.
  • Working knowledge of billing codes, Revenue Codes, CPT’s, etc.
  • Experience and knowledge of chargemaster, contracts, and revenue cycle functions.
  • Working knowledge of EPIC, Cerner and Excel.
  • Working knowledge of provider billing guidelines, payer reimbursement policies, and related industry-based standards.
  • Ability to examine financial and clinical data trends and provide recommended action plan.
  • Integrity and commitment to excellence.
  • Strong skills including analytical, verbal communication, written communication, customer service, time and project management, and leadership.

Managed Resources is an Equal Opportunity Employer (EOE) M/F/D/V/SO

Job Type: Full-time

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