[Hiring] RN Compliance & Charge Capture Auditor @Carle Health

Role Description

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)
• Education: Bachelor's Degree in Nursing

Requirements

• 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 conducts 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.

Benefits

• The compensation range for this position is $28.82 per hour - $49.57 per hour.
• Carle Health offers a comprehensive benefits package for team members and providers.