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Temp - Registered Nurse (RN) - Compliance Auditor (Days) Dallas, TX

IMCS Group Inc

Dallas, TX

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JOB DETAILS
SKILLS
Auditing, Clinical Research, Communication Skills, Consulting, Corrective Action, Customer Support/Service, Detail Oriented, Documentation, Establish Priorities, Government, Government Regulations, Healthcare, Healthcare Reimbursement, Identify Issues, Interpersonal Skills, Legal, Maintain Compliance, Medical Records, Nursing, Operational Audit, Organizational Skills, Patient Care, Patient Safety, Presentation/Verbal Skills, Quality of Care, Registered Nurse (RN), Regulatory Compliance, Reporting Skills, Time Management, Utilization Management, Writing Skills
LOCATION
Dallas, TX
POSTED
30+ days ago
Title: Temp - Registered Nurse (RN) - Compliance Auditor (Days) Dallas, TX

Description: Candidates living within 60 miles of the facility will have a local rate of ***

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.

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.
  • Detail-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
  • 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 theaudit process.
  • Explicitly and concisely document
    clinical and charge-audit findings in a way that can be easily
    understood by non-clinical personnel.
  • 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.
  • Conducts thorough
    research and provides
    prompt, courteous consultative services regarding
    compliance matters.
  • Assists in monitoring and responding to audits and/or inquiries from government agencies
    and their contractors.
  • Provides clinical
    knowledge as needed to help the department determine whether to make
    refunds/repayments to Federal healthcare programs.
  • 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.
  • Monitors changes
    in laws and regulations related
    to compliance and communicates changes
    to appropriate personnel.
  • 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.

About the Company

I

IMCS Group Inc

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