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Coordinator Clinical Audit Pharmacy DT

3 months ago

Naples, United States NCH Healthcare System Full time
DEPARTMENT: 17070 - Pharmacy DTLOCATION: 350 7th Street North, Naples, FL, 34102WORK TYPE: Part TimeWORK SCHEDULE: 8 Hour Day

ABOUT NCH

NCH is an independent, locally governed non-profit delivering premier comprehensive care. Our healthcare system is comprised of two hospitals, an alliance of 700+ physicians, and medical facilities in dozens of locations throughout Southwest Florida that offer nationally recognized, quality health care.

NCH is transforming into an Advanced Community Healthcare System(TM) and we’re proud to: Provide higher acuity care and Centers of Excellence; Offer Graduate Medical Education and fellowships; Have endowed chairs; Conduct research and participate in national clinical trials; and partner with other health market leaders, like Hospital for Special Surgery, Encompass, and ProScan.

Join our mission to help everyone live a longer, happier, healthier life. We are committed to care and believe there's always more at NCH - for you and every person we serve together. Visit nchjobs.org to learn more.

JOB SUMMARY

The Clinical Audit Coordinator performs detail analytical audit studies to verify accuracy of patient accounts. Provides back up for the Emergency Room / Utilization Review Auditor as needed. Conducts exit interviews with commercial audits and provides technical support to senior management, as well as the training of various departments’ personnel. Is also responsible for daily transaction audit report and monitoring departmental posting of charges in an accurate and timely manner. Communicates with directors of areas to resolve deficiencies. Responsible for the daily late charge report. Knowledge of all Medicare requirements, which includes APC’s, in addition to working with Medicare HMO Auditors. Provide CPT codes and develops new charge numbers to increase reimbursement.

ESSENTIAL DUTIES AND RESPONSIBILITIES

– Other duties may be assigned.

· Commercial audits: pre-audit accounts requiring an audit to verify detailed bill.

· Concurrent audits: reviews daily charges for accuracy.

· Performs required third party payer audits prior to billing.

· Provides charge and procedure pricing upon request.

· Acts as liaison to Patient Advocate program for patient accounting issues relating to charges.

· Attends meeting and participates when appropriate.

· Performs additional functions as required as they relate to Admitting/ Registration responsibilities.

· Actively assists and supports departmental activities to ensure that operational and salary expenses are equal to or less than approved budget.

· Understands the principles and concepts of Performance Improvement. Looks for opportunities and solutions for process improvements and seeks to improve job skills.

EDUCATION, EXPERIENCE AND QUALIFICATIONS

· High School Diploma or GED required.

· Minimum of 1 year of experience.

· RN with a current Florida License.

· Basic computer knowledge: ability to operate a PC, create/save/print documents, input data