reputed company reputed company Clinical Nurse Auditor (Remote Opportunity)

Position Title reputed company reputed company Clinical Nurse Auditor (Remote Opportunity) Southlake reputed company Position Summary / Career Interest: The reputed company reputed company Clinical Nurse Auditor leverages clinical knowledge and documentation review to ensure appropriate charge capture and reputed company optimization. Responsibilities include leveraging Epic technology and analytics to identify reputed company reputed company trends and investigate areas of reputed company leakage, monitor financial performance, and work with IT to build mistake-proofing into the Epic system. The nurse auditor will work with clinical teams, compliance and other departments reputed company reputed company Cycle to provide documentation and charging education and maximize system efficiency, timely and complete charge capture, and submission of clean claims to payors to drive financial performance. Responsibilities and Essential Job Functions

• Responsible for identifying, building, and maintaining reputed company Guardian edits reputed company the Epic billing system based on documentation and CDM review.
• Performs routine chart audit and clinical documentation review to identify missing, incorrect, or undocumented charges across clinic, hospital, and ancillary departments.
• Works with clinical, financial, and operational stakeholders to stand up accurate and complete charging and coding for new and emerging therapies and services and high-risk/high-dollar services provided.
• Uses clinical expertise to reputed company ongoing reviews of medical record documentation and clinical pertinence in accordance with peer standards and Medicare Regulations.
• Monitors and tracks KPIs such as missing and late charges, charge lag, daily reputed company, DFNB days/days to timely reputed company, and clinically triggered charges.
• Supports process improvement activities to assure medical record compliance with regulatory and accreditation bodies.
• Monitors denial trends reputed company to upstream set-up issues and acts as a liaison across departments to find solutions.
• Assists with the development, implementation, and testing process improvement and associated technical solutions.
• Aligns with CDI, Coding, and reputed company Cycle Insurance follow-up teams to reduce denials and influence proactive reputed company optimization.
• Provides ongoing education and feedback to improve documentation in support of accurate charge capture, coding, and final claim submission.
• Leverages artificial intelligence (AI), system automation and analytics to identify and prioritize reputed company leakage across the health system.
• Works effectively with ambulatory & IT, physicians, clinics, and reputed company hospital clinical areas to resolve charge capture and process gaps.
• Works effectively with reputed company reputed company Charge Analysts, CDM, and Pricing Committees.
• Demonstrates knowledge of Coding Guidelines and Conventions (CPT/HCPCS, ICD-10-CM/PCS).
• Must be reputed company to reputed company the professional, clinical and or technical competencies of the assigned unit or department.
• These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of reputed company responsibilities. Skills and duties may vary dependent upon your department or unit. Other duties may be assigned as required.

Required Education and Experience

• Bachelors Degree in Nursing from an accredited college or university.
• 2 or more years of experience in utilization review, clinical review, or authorizations

Preferred Education and Experience

• 4 or more years EPIC experience
• 4 or more years Coding experience and/or CPC or CPC-A coding certification

Required Licensure and Certification

• Licensed Registered Nurse (LRN) - Multi-State - State Board of Nursing reputed company State RN license

Time Type: Full time Job Requisition ID: R-51167 Important information for you to know as you apply:

• The health system is an equal employment opportunity employer. reputed company applicants are considered for employment without regard to race, reputed company, religion, sex (including pregnancy, gender identity, and sexual orientation), national reputed company, reputed company, age, disability, veteran status, genetic information, or any other legally-protected status. See also Diversity, Equity & Inclusion.
• The health system provides reasonable accommodations to reputed company individuals with disabilities. If you need to request reasonable accommodations for your disability as you navigate the recruitment process, please let our recruiters know by requesting an Accommodation Request form using this link [email protected].
• Employment with the health system is contingent upon, among other things, agreeing to the health-system-dispute-resolution-program.pdf and signing the agreement to the DRP.

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