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CLINICAL AUDITOR II REVENUE INTEGRITY

Company name
Owensboro Health

Location
Owensboro, KY

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Job Summary Performs medical and revenue audits to ensure revenue integrity as related to adherence to federal and state regulations: policies of external payers, coding rules and guidelines. Exercises independent decisions using analytical and problem solving skills. Provides critical analytical and negotiation support with respect to third party payer reimbursement contracts. Requires a strong understanding of the specialized concepts, practices, and procedures in the area of specialization. Requires some assistance in tasking and prioritizing but able to work independently. Job Responsibilities Responsible for conducting quality control audits to ensure data\/documentation integrity, communicating findings and recommendations, explaining regulatory requirements, and overseeing the corrective actions for audits within the operational units. Compiles information and\/or prepares reports and analyses, setting forth results of data integrity findings with appropriate recommendations; performs subsequent audits to ensure complete and appropriate corrective action has occurred. Follows up with appropriate staff members to ensure accurate and complete documentation in the medical record. Works collaboratively with the appropriate operational leaders to develop provider education strategies to promote complete and accurate clinical documentation and correct negative trends and is able to impart this knowledge to providers and other staff members. Conducts third party defense audits, concurrent audits and complaint audits as required. Assists with responding to patients' inquiries concerning the accuracy of billed charges and charge descriptions Assists with resolving third-party payor inquiries and billing disputes. Organizational Responsibilities Adheres to all organizational policies and procedures. Executes all tasks and behaves in a manner consistent with a culture of compliance, safety and a high reliability organization; behavior supports the organization's core commitments of Integrity, Service, Respect, Teamwork, Excellence, and Innovation. Education Associate's degree or higher in business, healthcare administration, nursing, or other related field is required. Bachelor's degree preferred. A combination of education, training and experience may be considered in lieu of degree. Licensure\/Certification\/Registration Licensed as a Registered Nurse (RN) required. Work Experience A minimum of 3 years' relevant experience required. Skills and Attributes Requires critical thinking skills and decisive judgment. Works under general supervision. Must be able to work in a stressful environment and take appropriate action. FLSA Classification Exempt Disclaimer This description is intended to describe the general nature and level of work performed by employees assigned to this position. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees. Specific duties and responsibilities consistent with the general nature and level of work described may vary by department and additional related duties may be assigned as needed. Some duties listed may not apply to all areas. Additional Position Related Details Populations Served Training is provided relevant to the population served, based on scope of care of the service assignment. Physical Requirements Activity and Frequency: Bending\/Stooping - Never Climbing - Never Keyboard Data Entry - Frequently Kneeling - Never Lifting\/Moving Patients - Never Lifting\/Carrying (Non-Patient) - 0-25 lbs - Never Lifting\/Carrying (Non-Patient) - 25-75 lbs - Never Lifting\/Carrying (Non-Patient) - over 75 lbs - Never Pushing\/Pulling - 0-25 lbs - Never Pushing\/Pulling - 25-75 lbs - Never Pushing\/Pulling - over 75 lbs - Never Reaching - Never Repetitive Foot\/Leg Movements - Never Repetitive Hand\/Arm Movements - Frequently Running - Never Sitting - Frequently Squatting - Never Standing - Frequently Walking - Frequently Audible Speech - Frequently Hearing Acuity - Frequently Smelling Acuity - Never Taste Discrimination - Never Vision: Depth Perception - Frequently Vision: Distinguish Color - Frequently Vision: Seeing - Far - Frequently Vision: Seeing - Near - Frequently Exposures Owensboro Health is committed to providing a safe working environment including training and access to person protective equipment necessary to this position. While performing duties of this position, occupational exposure to bloodborne pathogens is present for all employees.

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Owensboro Health

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