Director Nurse Auditing - Registered Nurse

Adventist Health System Sunbelt   •  

Altamonte Springs, FL

Industry: Healthcare

  •  

Less than 5 years

Posted 121 days ago

If you want to be a part of a place that provides nothing less than extraordinary compassionate care, then Adventist Health System is the place for you! We are currently seeking qualified candidates for a Director Nurse Auditing position that will be based in our Patient Financial Services department. This position is based at our corporate office in Altamonte Springs, FL.   This position provides the opportunity to be responsible for independently collaborating with the AHS Revenue Cycle and AHSIS teams in the design, development, maintenance and testing of the charge integrity tool integrated within the Cerner platform.  This position assists with the installation and training of all the Nurse, Emergency and Surgery auditors.  This position also strives to integrate clinical operational knowledge with coding, billing and revenue management processes in order to optimize revenue capture within AHS clinical departments.  This includes educating and assisting clinical departments as well as ancillary service areas with process flows that embed best practices into charge/revenue capture.       Specific job duties include:

  • Independently audits patient's records for accuracy of charging.
  • Utilizes audits to focus on key issues in the revenue cycle for improvement.
  • Problem solves and recommends appropriate process flows to maintain billing and clinical compliance as regulatory bodies/ authoratative sources publish updated or new rules, regulations and guidance.
  • Routinely identifies charge capture opportunities and makes recommendations to department leadership on how they can improve the accuracy of charge capture processes, including preparing and sharing work flow documentation.
  • Is familiar with all revenue cycle functions and how they are impacted by the charge correction tool and revenue integrity processes and procedures.
  • Maintains the Nurse Auditor scorecard, and makes changes as needed to reflect the most pertinent KPI’s.
  • Reviews and approves change requests related to the charge correction tool and coordinates with AHS IS to implement approved changes.
  • As needed, communicates changes to nurse audit workflows to ensure they reflect current priorities and support best practice in nurse auditing.
  • Remains abreast of new regulatory requirements and reimbursement changes at the State and Federal level, and adjusts charging practices and system rules to address these changes.
  • Acts as liaison between clinical and revenue management departments, fostering a positive relationship between these areas to effectively address issues and challenges as they arise.
  • Proactively monitors the status of the charge correction tool to ensure the system is working as designed, and quickly addresses issues when outliers are identified.
  • Assists in the installation and maintenance of the charge correction tool, including preparing facilities to effectively use the tool and minimize billing delays
  • Consistently communicates with nurse audit leaders across AHS, keeping them abreast of Corporate PFS related activities, policy/procedure changes, system and software changes. Etc.
  • Works effectively with the Corporate PFS Training and Education team to produce timely and meaningful training materials related to the charge correction tool and the clinically driven revenue cycle.
  • Trouble-shoots nurse-audit related problems for member hospitals, always responding in a timely fashion and including other subject matter experts as needed to address these issues in a timely and accurate manner.
  •  Performs other duties as assigned by Executive Director of Patient Financial Services and the Vice President of Revenue Management.

Experience Requirements:

  • Minimum 3 years’ experience in hospital nurse auditing or related field

Educational Requirements:

  • Registered Nurse

Knowledge and Skills Required:

  • Strong computer skills, including competency in the core Microsoft Office applications
  • Ability to quickly learn new hardware and software applications, including legacy/core patient accounting systems.
  • Demonstrated ability to be self-directed and to work with minimal supervision/oversight