Clinical Audit Specialist

4 weeks ago

Baltimore Maryland, United States University of Maryland Medical System Full time
Job Summary

Under general supervision, conducts internal audits of hospital bills working with external auditors to ensure that uncompensated patient revenues resulting from audits of patient service billings (claims) are minimal. Utilizes information obtained from the audit process to inform and educate UMMS personnel concerning clinical reimbursement results and practices.

Key Responsibilities
  • Plans work for self and with coworkers, including setting goals, prioritizing work and coordinating the execution of work. Determines work priorities and resource allocation across multiple clinical audit activities based on interpretation of data and reports.
  • Gathers and records data used for individual, team, and feedback performance reporting. Responsible for the integrity of recorded information.
  • Communicates with representatives of external audit companies, insurance companies, UMMS personnel, and regulatory agencies to ensure congruence with and understanding of UMMS' audit policy, process, practice and standards.
  • Provides concurrent review of charge capture prior to claim submission in order to maximize reimbursement and reduce revenue loss through audit process.
  • Works with the Director in the identification and research of denials received for lack of authorization and for lack of medical acuity continued stay and coordinates drafting of the facility's appeal responses.
  • Designs and implements special audit and education projects.
Requirements
  • Registered nurses working within UMMS shall follow the guidelines for professional practice promulgated by the Maryland State Board of Nursing.
  • Must be able to communicate effectively with immediate supervisor and provide information regarding work progress, actions and issues in a timely manner.
Working Conditions

Works in a fast-paced environment with multiple priorities and deadlines. Must be able to work independently and as part of a team.

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