RN Nurse Auditor in Memphis, TN at Acadia Healthcare

Date Posted: 7/8/2019

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Memphis, TN
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    7/8/2019

Job Description

Job Duties

  • Performs reviews of medical charts
  • Validate both the coding accuracy and appropriateness of services given to inpatients
  • Record audit determinations using an audit tracking system to create a narrative explaining the rationale behind the care given to patients
  • If an appeal arises, be able to support findings
  • Consult with physicians, patients, and other staff as needed
  • Assist with quality assurance functions such as development of coding guidelines as needed
  • Maintain all required certifications to ensure ability to perform audits
  • Demonstrated competency in claim review and experience using billing and claims forms.
  • Proven knowledge of medical and surgical procedures and other healthcare practices.
  • Proven competency to apply clinical expertise to ensure compliance with medical policy.
  • Knowledge in reading and interpreting medical records and patient data with an ability to communicate effectively with clinical and non-clinical staff.
  • Knowledge of personal computer software, such as Microsoft Word, Excel, PowerPoint and Access.
  • Ability to prepare and present clear and concise written narratives and reports.
General Functions and Outcomes
  • Conducts coding audits, quality assurance assessments of claims, reviews statistical samples and analyzes for risk.
  • Applies nursing expertise to ensure compliance with medical policy, medical necessity guidelines and accepted standards of care.
  • Conducts audits to determine if claims adhere to specific provider and hospital contracts.
  • Ensures that medical claims, medical records and other documentation essential to proper billing is in compliance with federal regulation, company policies and industry standards.
  • Develops written audit findings with respect to contractual compliance, recommendations for improved contracts, and other matters identified during the audit.
  • Writes audit reports, as applicable. Assesses and communicates the level of risk associated with the audit issues identified in the report.
  • Conducts surveys of complex audit areas to define the scope and objectives of audits.
  • Assists in the development of overall audit plans, including comprehensive audit programs that identify specific procedures and tests designed to achieve the audit objectives.

Education and Experience

  • A minimum of an Associate’s Degree in Nursing or a related field is required
  • For some positions, a Bachelor’s Degree in Nursing or a related field is preferred
  • Must maintain a current Nursing certification in their state of practice
  • Some (1-2) years of clinical knowledge or experience in Case Management preferred
  • Strong problem solving skills are a must

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