Nurse Reviw Auditor
Location: St. Louis Missouri
Description: The Outsource Group is at present looking to employ Nurse Reviw Auditor right now, this job will be placed in Missouri. More complete informations about this job opportunity please give attention to these descriptions. BASIC FUNCTION: The purpose of the Nurse Auditor which includes, Internal Recovery Audits or (RAC) position is to protect the assets of the Client through a timely, accurate ! review of records in order to assure compliance with all regulatory requirements. The intent of the record is to evaluate the patient record for medical necessity, adequacy and quality of documentation and compliance with all applicable regulatory guidelines. The underlying objective of the auditor is to assure that documentation exists to support billing and coding. Additionally the RAC Auditor will evaluate opportunities for education around billing, compliance and quality of documentation and make recommendations to the System Executive and Directors of Care Management for the ongoing development of continuing education. The role integrates and coordinates utilization management, clinical documentation and regulatory compliance.
ACCOUNTABILITY/ DUTIES :
The Auditor is accountable for a designated review caseload and plans effectively in order to meet review deadlines, and coordination of second level reviews with campus departments. They also work in ! conjunction with Patient Business Services to coordinate work ! flow processes and recommendations specific to the review process.
Specific functions within this role include:
- Review of records against appropriate criteria sets and clinical guidelines
- Document findings in electronic systems for future reference and audit reports
- Coordinate findings with Clients to secure consensus with recommendations
- Initiate rebilling of records, following defined protocols, following campus level review
- Coordinate billing activities with appropriate parties to assure timely compliance with deadlines
1. Current and valid license to practice as a Registered Nurse (ADN or BSN) in the state of MO
2. Professional certification as a Case Manager or Nurse Auditor preferred but not required
3. Three or more years of clinical experience
4. Excellent written and verbal communications skills.
5. Strong analytic! al, data management and PC skills
6. Current working knowledge of utilization management, case management, regulatory requirements and reimbursement. 7. Understanding of services available across the continuum of care
8. Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components along with critical think skills required.
9. Ability to work independently, exercise sound judgment, be detail oriented and meet strict deadlines.
10. Demonstrates commitment to TOG and their clients by integrating our culture in all internal and external customer interactions. 11. Possess knowledge of CMS rule and regulations Ability to manage multiple tasks including desk audits and claims review. 12. Must be able to independently use standard office computer technology and have experience using case management systems/tools to review and document findings. 13. Must be able to handle multiple assignment effectively, ! create documentation outlying findings and/or documenting suggestions, ! organize and prioritize workload, problem solve, work independently and with team members.
14. Flexibility to handle any non-standard situation that may arise
REQUIREMENTS:
RN/LVN with solid Clinical experience. Experience in case management, utilization review, Interqual criteria (medical necessity review) and/or auditing strongly preferred. Understanding of Medicare and Medicaid billing and regularity regulations required.
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If you were eligible to this job, please email us your resume, with salary requirements and a resume to The Outsource Group.
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This job starts available on: Mon, 25 Nov 2013 09:32:20 GMT