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Registered Nurse
2 months ago
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 Payors 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.
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.
~ 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.
~ 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 patients chart with services and items included on the patients bill, on a daily basis or upon request from Payors 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. FINANCE ESSENTIAL FUNCTIONS
~ Organizes and reconciles daily workdrivers to ensure accountability of all audits assigned and to ensure audits are worked in proper priority. 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.
~ 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
RN-Temp - Registered Nurse - Temporary State Licensure within 60 days
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
~ Computer proficiency to complete job duties independently
~ Expertise in medical staff quality initiatives
~ TRAVEL
Travel specifications may vary by department**
May require travel within the Houston Metropolitan area Yes
May require travel outside Houston Metropolitan area Yes
Houston Methodist Cypress Hospital, scheduled to open in the first quarter of 2025, will be Houston Methodists ninth hospital and will incorporate the most advanced technology available from the day the doors open. 290 corridor, the hospital will be equipped with technologically advanced innovations implemented during COVID, many of them designed to make patient communication with physicians, staff and families the very best and most effective in any health care facility. Even though the hospital wont be fully operational until 2025, we have several services and specialties opening in 2024.
Houston Methodist is an equal opportunity employer inclusive of women, minorities, disabled persons and veterans.
Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law. VEVRAA Federal Contractor – priority referral Protected Veterans requested.
