Adventist Health System Clinical Audit Manager in Altamonte Springs, Florida

Description

Work Hours/Shift

Full Time, Monday-Friday

Adventist Health System Corporate Office

Be part of the Adventist Health System family.

Where you work matters. Working here is like being part of a family. Not just with those you serve, but also with your team members. It’s about making a difference, saving lives, and helping others live a fuller one. You’ll be joining a family of tens of thousands of team members who understand that what they do is bigger than healthcare. It is living out our mission to Extend the Healing Ministry of Christ and being there for someone every step of the way-body, mind, and spirit.

This is more than a career. It is a calling.

With hospitals and facilities in 9 states, you’ll have endless opportunities to take your talents, develop your skills, and grow as a professional in a place that truly cares about your success. If you are driven, compassionate, someone who always wants to go above and beyond because you care and believe what you do makes a difference Adventist Health System is for you.

GENERAL SUMMARY:

The Clinical Audit Manager is responsible for management and oversight of the nurse audit of charges and documentation between the Cerner and CPA solutions promoting standardization, best practices, and ensuring correct capture of clinical revenue. Engages the nurse audit team and monitors the Discharged Not Finally Billed (DNFB) report. Produces and distributes information on errors to management and facility/regional auditors as well as provides necessary education materials and training conference calls with the team. Supervises the Facility Nurse, Emergency Department and Operating Room Auditors which includes regional and local hospital auditor positions. Collaborates with other corporate teams that support the electronic medical record.

Qualifications

What you will be responsible for:

  • Independently audits patient’s records for charge accuracy and uses that information to identify key issues in the revenue cycle for improvement. Communicates these issues and suggestions for improvement to the Corporate Director of Nurse auditing.

  • Create, develop and present training materials for nurse auditors and others involved in the audit process utilizing various tools such as Power Point, Excel, Skype, etc.

  • Proactively identify areas for improvement in charge capture and communicate these effectively to the Corporate Director of Nurse Auditing. Propose solutions and collaborate with education materials and guidance to nurse auditors across the system.

  • Remains current on new regulatory requirements and reimbursement changes at both the State and Federal levels in order to adjust charging practices, information system and rules within Revenue Cycle applications, in collaboration with the Corporate Charge Master and AHS-IS Charge Services.

  • Routinely identifies charge capture opportunities and suggests improvements to department leadership while suggesting an operational work flow to implement a successful charge capture process.

  • Supports total PFS department efficiency. Learns other PFS functions such as SSI claim submission, AR reporting, and payer denials.

  • Effectively supports AHS IS changes and system deployments. Collaborates with and support the Corporate Director of Nurse auditing with system deployment, implementation planning and execution that is customized to each facility’s needs and culture while optimizing revenue cycle application usage and revenue integrity for the AHS system especially amongst audit and clinical staff. Support will include travel to various system facilities.

  • Work as liaison between clinical and non-clinical departments in a collaborative fashion, supporting the clinically driven revenue cycle.

  • Analyze the utilization of best practice in nurse auditing and revenue capture, eliminating areas of ambiguity while educating facilities on achieving best practice where feasible thus supporting and encouraging effective and compliant revenue/charge capture.

  • Supports training and orientation activities for current and in-coming nurse audit personnel.

What you will need:

  • Bachelor’s degree, preferably RN

  • 2-years of revenue management and/or audit experience or related field and 2 years clinical experience

  • RN Registered Nurse

  • Researches and remains current in regulatory requirements and reimbursement changes at State and Federal levels

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.