Quality Control Coordinator - St. Francis Medical Center, Grand Island, NE
Location: Grand Island Nebraska
Description: Conifer is employing Quality Control Coordinator - St. Francis Medical Center, Grand Island, NE right now, this vacancy will be placed in Nebraska. For complete informations about this vacancy opportunity kindly see the descriptions. Description
Description
At Conifer Health Solutions, we offer the strength and stability o! f Tenet Healthcare, a Fortune 500 company, with the ingenuity and energy of a healthcare independent. We are a healthcare solutions company born from the healthcare industry. We take care of hospital business, so hospitals can focus on caring for patients. Ready to be part of our solutions? Welcome to a company that gives you the resources and incentives to redefine healthcare services, with the benefits and leadership to take your career to the next step!
General Summary
Under minimal supervision, performs audits in accordance with the approved audit plan and prepares oral
and written communication to the CFO, Department Directors and other designated recipients on the
results of audits performed. Audits patient bills, responds to inquiries from patients and payers, interprets
laws and regulations, and provides guidance and education to departments.
Uses and discloses patient protected health information: 1) Only! as it applies to job functions, 2) in
amounts minima! lly necessary for intended purpose, and 3) in a confidential manner.
Principal Duties and Responsibilities Performs audits by the selection of a random sampling of accounts. Then compares the billing statements which may include the itemized patient bill and the UB02 to the medical record documentation for accuracy of the charge capture, coding accuracy, medical necessity and compliance with applicable billing rules and regulations. Prepares oral and written reports utilizing Excel spreadsheet and Word software programs for the audit findings. These reports are submitted to the CFO and applicable department directors communicating the findings and recommendations for action plans if necessary per the audit findings. Will be available for the department to give information on the necessary changes if necessary. A schedule for the follow-up audit will be determined to review the completion of the Action plan. Coordinates and conducts defense audits with third party p! ayers. After receiving audit report reconciles the differences and reaches an agreement on final adjustment to the patient bill if necessary. Post the corrections or adjustment. Works with the Revenue Realization Center (RRC) for the billing corrections and the refunds if required to complete the audit review. Responds to patient billing concerns or other departmental inquiries. Compares the patient bill with the medical record documentation and communicates the results to Department Director and the Revenue Realization Center (RRC). Provides guidance and education as requested to hospital departments that require assistance related to charges or compliance issues based on interpretation of current laws and regulations. Performs audit functions related to government changes clarification and investigations as directed. Prepares the annual department audit plan, this includes the selection of high risk areas for review, works with the Corporate Responsibility - Billing Sub-c! ommittee, CFO in this determination. Prepares monthly activity report a! nd other reports as required within the established time frames. Records the results and keeps documentation of all audits per facility record retention. Attends Corporate Responsibility Program Billing Practices and Patient Care subcommittees and actively participates as a member. Maintains knowledge of current trends and developments in the field by reading appropriate books, journals, and other literature and attending related conferences, seminars and the like.
Qualifications
Minimum Knowledge, Skills and Abilities Required Ability to read and interpret patient bills and medical records documentation, perform noncomplex mathematical calculations and interpret and apply laws and regulations when auditing medical records and patient bills as normally acquired through completion of a Bachelors degree in Health Information Management, Nursing or other related field. Prior auditing experience desired. Approximately three years of relevant clinical experienc! e necessary in order to understand relevant patient billing, medical record procedures, laws and regulations and hospital operations. Relevant clinical experience includes primary care nursing, medical records coding, case management, utilization review and third party defense audits. Familiarity with general Medicare billing regulations and knowledge of ICD-9, CPT and HCPCS coding required. Basic computer skills and a working knowledge of Microsoft Office products and understanding of internet research desired. Interpersonal skills and tact necessary to gather and exchange audit information with Department Directors, Senior Management, patients, and third party payers as well as personnel in other departments of the hospital. Must facilitate problem solving teams, present solutions for audit issues and provide guidance and education to hospital staff based on interpretation of current laws and regulations. A high level of analytical skills necessary to review and detect er! rors in patient billings, determine appropriate action to resolve audit! errors, interpret and apply laws and regulations, analyze audit trends/findings, develop solutions and provide guidance to staff in correcting audit issues. Ability to concentrate and pay close attention to detail for up to 85% of work time when auditing patient billings.
Working Conditions Normal office environment with little exposure to excessive noise, dust, temperature and the like.
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If you were eligible to this vacancy, please email us your resume, with salary requirements and a resume to Conifer.
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This vacancy starts available on: Mon, 27 May 2013 13:05:17 GMT
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