Job Description

At Houston Methodist, the Nurse Auditor position is responsible auditing and reconciling patient charts (i.e. medical record) on a daily basis or upon request from Payor's on-site auditors, Patient Accounting, Risk Management, Revenue Cycle, and other hospital entities needing completion of audit for reasons of treatment, payment or operations to ensure accuracy and in compliance with regulatory requirements, hospital and system policies and procedures. This position will complete audits to ensure that the clinical documentation contained within the patient chart supports items and services included on the patient bill and identifies and corrects errors or discrepancies to accurately support reasons for treatment, billing, payment or operations. The Nurse Auditor position ensures clinical documentation supports all patient billing, verifies all patient services are listed for payment, prepares reports of discrepancies/exceptions and provides recommendations for corrective action. This position ensures complete and timely responses to requests from hospital, other Houston Methodist entities, and Corporate for additional needed information, or further audits. The Nurse Auditor position responds to audits in the form of verbal exit conferences and/or a written exchange of findings.

Requirements:

PEOPLE ESSENTIAL FUNCTIONS

• Collaborates and works fluidly with the Business/Finance office(s) to communicate audit results. Delivers a list of exceptions needing corrective action based on audit results to management.

• Opens and reviews case records for consistency and accuracy in documentation. Trains and educates staff on documentation and charging process.

• Collaborates, as appropriate, with outside auditors who audit specific patients accounts for items not documented and to determine what is and is not allowable.

• Provides contributions to improve department scores for turnover/retention.

SERVICE ESSENTIAL FUNCTIONS

• Assists with intradepartmental data collection associated with various external, internal, and administrative audits.

• Prepares and presents monthly audit reports complete with findings of discrepancies or exceptions.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• Audits and reconciles patient charts, services and items included in the patient's chart with services and items included on the patient's bill, on a daily basis or upon request from Payor's on-site auditors, Patient Accounting, Risk Management, Revenue Cycle, and other network hospital entities needing completion of audit for reasons of treatment, payment or operations. Performs quality and safety audits through review of patient and other records, through direct observations, as appropriate. Exercises sound clinical judgment, discretion and initiative when performing data audits.

• Intervenes and takes appropriate action to foster real-time compliance to performance measures associated with regulatory, national, and regional guidelines. Interventions to promote compliance may include discussion, and/or collaboration with physicians, nurses, other healthcare personnel, and patients.

• Utilizes results from performance improvement activities to identify and prioritize areas of focus for improvement. Evaluates and provides input on the effectiveness of performance improvement programs. Role models situational awareness, using teachable moments to improve safety.

FINANCE ESSENTIAL FUNCTIONS

• Organizes and reconciles daily workdrivers to ensure accountability of all audits assigned and to ensure audits are worked in proper priority. Recognizes that customer service and fiduciary responsibility must be balanced.

• Effectively models independent time management and prioritization of daily tasks.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

• Fosters identification and implementation of innovative solutions to improve department operations by leading and/or participating in hospital projects and shared governance activities where appropriate.

• Identifies and assumes responsibility of own learning needs, seeks continuing education opportunities to meet those needs. Completes and updates the My Development plan on an on-going basis. Ensures own career discussions occur with appropriate management.

This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.

Qualifications:

EDUCATION

• Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certifications, Licenses and Registrations section.

WORK EXPERIENCE

• Three years of hospital clinical experience, preferably in a surgical setting

• One year of experience auditing in a surgical or hospital setting

LICENSES AND CERTIFICATIONS - REQUIRED

• RN - Registered Nurse - Texas State Licensure and/or Compact State Licensure within 60 days OR
• RN-Temp - Registered Nurse - Temporary State Licensure within 60 days

KNOWLEDGE, SKILLS, AND ABILITIES

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations

• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security

• Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles

• Ability to learn and apply use of databases for aggregation of data for analysis

• Ability to independently analyze and solve problems

• Computer proficiency to complete job duties independently

• Expertise in medical staff quality initiatives

• Strong research interpretation skills

• Time management and prioritization skills

• Flexibility and ability to adapt to change

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

• Uniform No
• Scrubs Yes
• Business professional Yes
• Other (department approved) Yes

ON-CALL*
*Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.

• On Call* No

TRAVEL**
**Travel specifications may vary by department**

• May require travel within the Houston Metropolitan area Yes
• May require travel outside Houston Metropolitan area Yes

Job Tags

Full time, Temporary work, Work experience placement,

Similar Jobs