Ensures regulatory accuracy and compliance in clinical documentation, the financial records and service processes. Educate staff and specific departments regarding regulatory changes with assistance in implementation of these changes. Audit and defend Medicare revenues earned.
Two years general experience in a hospital. Experience as a Nurse Auditor in a hospital or audit firm.
Registered Nurse - N.H. State or Valid Nursing License in another Compact State
1. Ensures accuracy of the patient's financial records.
2. Schedules, controls, and executes retrospective audits of the patient's financial bill as dictated by the audit policy for the purpose of identifying charge omissions, documentation deficiencies, unsupported charges and to maximize reimbursement. Makes corrections as indicated.
3. Works closely with the Patient Accounts Department to ensure submission of corrected bills/claims when necessary.
4. Transfers charges to the correct patient record when necessary.
5. Reports documentation deficiencies, billing errors, and trends to the appropriate Department Managers.
6. Provides education to staff on charging and documentation process to decrease discrepancies on patient bills.
7. Maintains current understanding of ancillary department's clinical procedures, patient charge protocols and systems.
8. Maintains current knowledge of the hospital Charge Description Master.
9. Reviews Daily Departmental Charge Report.
10. Prepares monthly and annual summaries of patient account audit activity for each revenue department, CFO, VP of Finance, Accounting and the Patient Account Manager.
11. Develops and maintains policies and procedures relating to patient audits, and actively contributes to continual process improvements.
12. Actively participates with the review of changes to the Charge Description Master in relation to regulatory compliance.
13. Performs other duties as assigned by supervisor.