[Hiring] Registered Nurse-Clinical Auditor Sr @UnityPoint Health

Role Description

This position assumes the lead role in planning, organizing, and conducting clinical compliance and operational audits of various functions, departments, and/or activities of UnityPoint Health (UPH) and its affiliates. Candidates can expect to identify and evaluate clinical areas of vulnerability and regulatory risk and collaborate with UPH Management to strengthen the internal control environment and improve clinical documentation and reimbursement.

Hours: Monday-Friday, standard business hours

Location: Remote - applicants preferably reside within the UPH footprint of Iowa, Illinois, or Wisconsin

Responsibilities

• Clinical Documentation & Coding Auditing:
  • Demonstrates knowledge of basic audit skills and adheres to Internal Audit Standards and UPH Internal Audit policies and methodologies.
  • Utilize system software to efficiently research, document, and test areas of risk.
  • Validate diagnosis and procedure codes assigned are adequately supported by documentation in the medical record.
  • Regularly researches and utilizes outside resources to maintain and update knowledge of trending risks and best practices within the healthcare industry.
  • Communicates audit test results and collaborates with UPH Management to identify effective action plans to address audit findings; follows up with UPH Management to ensure action plans are implemented timely.
• Improvement:
  • Researches and develops appropriate audit programs and testing procedures that address compliance with clinical documentation requirements, coding, billing, and other regulatory issues.
  • Assesses clinical documentation, coding, and billing practices for compliance with regulations of federal and state agencies and third-party payers; develops sound conclusions supported by audit evidence; identifies opportunities to improve compliance and operating efficiency.
  • Works with management to improve UPH staff education, compliance, and controls related to clinical documentation, coding, billing, and other regulatory issues.
  • Assists Internal Audit Management with research and/or risk interviews during the annual risk assessment. Provides input on the preparation of the annual Audit Plan.
  • Participates in establishing and preparing departmental goals, standards, procedures, and instructions which contribute to the efficiency and effectiveness of the department.
• Projects:
  • Works collaboratively with other staff members to ensure optimal team functionality.
  • Provides status reports on a regular basis for assigned projects.
  • Maintains a high level of independence and objectivity.
  • Performs special audit assignments and investigations as required.

Qualifications

• BSN - Bachelor's degree in nursing
• Current RN license required

Requirements

• Minimum of five years audit and/or clinical chart review experience with a healthcare organization or insurance company. Experience should be related to one or more of the following: coding, billing, proper documentation, medical necessity, and/or reimbursement.
• Working knowledge and experience with medical terminology, patient care services, medical record chart documentation (inpatient and outpatient), ICD-9 and ICD-10 diagnostic and CPT procedural coding.
• Experience with medical coding and/or medical records documentation audits is preferred.
• Familiarity with the Epic electronic medical records platform preferred.

Benefits

• Expect paid time off, parental leave, 401K matching, and an employee recognition program.
• Dental, health, and vision insurance, paid holidays, short and long-term disability, and more.
• Early access to earned wages with Daily Pay, tuition reimbursement to help further your career, and adoption assistance to help you grow your family.