RN Compliance & Charge Capture Auditor

Overview

• Responsible for auditing accounts prior to billing according to coding, regulatory, and payor policy guidelines. Addresses debit and credit charging errors to assure correct final bills. Audits documentation to make sure the chart documentation matches the charges on the patient account. Tracks and analyzes data trends, reporting those trends back to clinical directors and providing additional education to clinical staff where appropriate. Performs daily audits on all Inpatient and Observation accounts. Responsible for quarterly focused audits of areas with suspected or confirmed problems.
• Qualifications
• Certifications: Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR)Illinois Department of Financial and Professional Regulation (IDFPR)Illinois Department of Financial and Professional Regulation (IDFPR), Education: Bachelor's Degree: Nursing, Work Experience:
• Responsibilities
• Performs daily audits of all Inpatient, Observation, ED and Outpatient Infusion via WQ monitoring, review of department revenue variance, and collaboration with operational areas.
• For Observation accounts, auditor is responsible for analyzing number of hours charged and whether all are appropriate according to regulation. Submits non-billable observation hours needing manual carve out to Revenue Integrity Charge Capture Specialist team for charge resolution.
• For Observation accounts, auditor is responsible to add all IV infusion and injection charges according to the Centers for Medicare and Medicaid Services (CMS) guidelines.
• Responsible for tracking and trending charge anomalies and reporting them back to the appropriate clinical department director.
• Responsible for ad hoc training/retraining of clinical staff as needed.
• If there is a charge, but no documentation, auditor is responsible to contact the department director or manager to validate charge appropriateness and ensure completion of documentation.
• In partnership with Revenue Integrity leadership, plans, coordinates, and conduct audits/ internal control evaluations and reviews as scheduled. Presents project results to leadership team.
• Maintains knowledge of clinical documentation standards and charge related regulations and standards. Applies knowledge to ensure that charges are accurate and supportable according to payer and regulatory requirements.
• Manages large complex projects, investigates and analyzes issues at a high level with strong attention to detail.
• Completes and/or attends training and education sessions as assigned by leadership.
• About Us
• Find it here.
• Discover the job, the career, the purpose you were meant for. At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities. Find it all at Carle Health.
• * Our nearly 17,000 team members and providers work together to support patient care across central and southeastern Illinois. We’ve grown to include eight, award-winning hospitals and a multispecialty provider group with more than 1,500 doctors and advanced practice providers. We’re developing the next generation of providers and healthcare professionals through Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Methodist College. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.
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• We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: [email protected].

Compensation and Benefits

The compensation range for this position is $28.82per hour - $49.57per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. The actual compensation offered a candidate will be dependent on a variety of factors including, but not limited to, the candidate’s ex Apply To This Job