Conducts concurrent and retrospective audits / studies to analyze processes and various aspects or components of operations in accordance to regulatory requirements, including clinical, fiscal-related, and other operational functions.
1.Performs document / chart reviews for critical functions including:
•Areas of organizational key processes and / or issues identified through process reviews, etc.
•Special audits of individual staff documentation
•Routine and special audits with financial implications
•Special audits of industry wide issues (issues identified by NHPCO, OIG, etc.)
•Third party payor requests for chart information, such as CMS
•Issues identified as high risk or problem prone
•Areas of special interest related to adverse events
2.Assists with providing aggregate performance data for departments / clinical teams, management decision support, electronic medical record utilization, etc. as directed by Director of Compliance & Audit (supervisor)
3.May assist with design of action plans to improve outcomes, including technology utilization as directed by supervisor
4.Requests for audits / studies will be prioritized in collaboration with supervisor
5.Prepares audit / study results in an understandable format to be provided to the Director of Compliance & Audit (supervisor) and may assist in presenting results to the colleagues who will be affected
6.Supports the Mission, Vision, Values, and Purpose of Tidewell Hospice and follows Tidewell’s Standard of Ethical Conduct
7.Maintains and assures confidentiality / validity of all patient information (PI), PI data and databases
8.Demonstrates professionalism in verbal and written communication
9.Responds to requests for assistance in a timely manner
10.Demonstrates commitment to professional growth and competency
11.Treats all customers and colleagues with respect
12.Responds to requests from regulatory agencies in a timely manner as directed by supervisor
13.Performs other duties as assigned
14.Assists in corporate compliance education as assigned and promotes a culture of compliance in the workplace.
The above statements reflect the general duties considered necessary to describe the principal function of the job as identified, and shall not be considered as a detailed description of all the work requirements that may be inherent or required in the position.
1.Frequently required to sit for prolonged periods of time
2.Seldom required to lift / push / pull more than 20 pounds.
3.Constantly required to perform simple manipulative skills such as typing, using a computer mouse, a calculator and writing.
4.Requires mental alertness, detail-oriented, ability to concentrate and good analytical skills.
5.Must be able to work independently and as part of a team
6.Ability to communicate effectively with colleagues at all levels in the organization.
7.Able to travel to team offices.
1.Florida licensed RN
2.Previous Quality Monitoring / Quality Improvement / Utilization Review experience required.
Knowledge, Skills and Abilities Required:
1.Computer skills: Word, Excel, and Windows; others, such as PowerPoint, are very desirable
2.Knowledge of electronic medical records systems is very desirable
3.Good communication skills
4.Knowledge of data display techniques
5.Ability to organize information for analysis by colleagues at all levels within the organization
6.Must be detail-oriented
7.Must be committed to maintaining timeline objectives
8.Must understand and be committed to confidentiality regarding protected health information and attorney-client privileged information
9.Ability to tactfully and respectfully communicate (without compromise) compliance requirements in situations where those requirements may mean inconvenience and change to those they affect
Machines/Equipment, Tools Used:
1.Computer and Windows-based computer applications
Responsible to: Director of Compliance & Audit
Tidewell Hospice - 12 months ago