Compliance Nurse Specialist

5 days ago

Creve Coeur MO, United States Bethesda Health Full time

Compliance Nurse Specialist (RN) at Bethesda Health summary:

The Compliance Nurse Specialist (RN) is responsible for conducting audits of medical billing documentation for third-party claims, especially Medicare and Medicaid, ensuring compliance with regulations. This part-time position involves educating clinical staff on proper documentation practices, preparing audit reports, and collaborating on resolving billing issues. The role requires a registered nurse with experience in long-term care and knowledge of Medicare and Medicaid guidelines.

Bethesda Brings out the Best in Talented, Caring People

At Bethesda, more than 1,200 employees dedicate their careers to improving the lives of others.

As a team member at Bethesda, you'll enjoy great benefits such as: 403b, daily pay, bonuses, career advancement opportunities, and holiday pay.

Medical, dental, vision, prescription, and life insurance available for regular status full and part time employees.

This is a Part Time Hourly Position

Summary

Responsible for conducting audits of the medical billing documentation supporting claims billed to third parties, particularly Medicare and Medicaid. These audits determine whether services provided to residents and billed, are consistent with medical record documentation and in accordance with appropriate third-party billing regulations and/or standards. Findings are communicated to appropriate personnel. Emphasis will be placed on MDS auditing and best practices documentation. Conducts internal audits of medical documentation supporting claims billed to third parties and billing is done in accordance with appropriate third-party regulations/standards. Assists in education of clinicians and billing staff to support compliance with third party documentation and billing standards. Provides education to clinical staff in the proper use of EMR reports related to documentation in the MDS. Prepares written reports of the results of the audits and presents them to management and billing staff with recommended corrective actions. Responds to questions from nursing / billing staff regarding billing, coding and documentation. Works on joint projects with other internal compliance staff to resolve billing and documentation issues. Follows established policies and procedures, quality assurance, safety, environmental and infection control standards. Assists with periodic clinical reviews of long-term care communities in preparation for governmental or other accrediting body inspections. Assists with periodic review of Quality Measures and education of the interdisciplinary team. Monitors documentation patterns for accuracy of information through the use of reporting mechanisms within the electronic medical record software.

Job Qualifications

  • Registered nurse, bachelor degree preferred
  • Active RN license in Missouri and Illinois, or willing to obtain as soon as possible
  • Two years of Long-Term care experience, with at least one year as MDS Coordinator
  • Acute care highly desirable
  • Knowledge of Medicare and Medicaid required
  • Experience training/teaching adults preferred
  • Software skills in Word, Excel, Power Point or equivalent required
  • Basic knowledge of and experience utilizing a personal computer
  • Verbal and written communication skills
  • Excellent interpersonal and organizational skills
  • Manual dexterity, coordination and skillful use of hands for working with required equipment
  • Ability to receive and express detailed information through oral communication, visual acuity
  • Ability to read and understand written directions

Category: RN

Keywords:

Compliance Nurse, Registered Nurse, Medical Billing Audits, Medicare, Medicaid, Healthcare Compliance, Long-Term Care, Clinical Education, Documentation Standards, MDS Coordinator

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