RN Clinical Auditor

Houston, TX 77030

Posted: 06/24/2024 Employment Type: Remote Profession: Coding Auditor Job Number: 90090 Pay Rate: $1,772 - $1,969 Specialty: HB

Job Description

The ideal candidate should be a BSN nurse with critical care experience.

Minimum Qualifications
Education:  Bachelors of Nursing required. Masters of Business or Healthcare Administration preferred.
Licenses/Certifications: Current and valid license to practice as a Registered Nurse in the state of Texas.
Experience / Knowledge / Skills:
    • Minimum five (5) years experience in finance, operations, audit, or consulting with a hospital or managed care focus
    • Minimum five (5) years clinical experience; preferably critical care
    • Knowledge of the American Association of Medical Audit Specialists standards and TJC Core Measures as appropriate
    • Knowledge of Medicare/Medicaid regulations
    • Excellent analytical, critical thinking, communication, and interpersonal skills
    • Strong PC skills including Word, Excel, and Access
    • Application development experience and a working knowledge of ERP software (e.g. Lawson, SAP, etc.) highly preferred.
    • Demonstrates commitment to the Partners-in-Caring process by integrating our culture in all internal and external customer interactions; delivers on our brand promise of “we advance health” through innovation, accountability, empowerment, collaboration, compassion and results while ensuring one Memorial Hermann.

Principal Accountabilities
    • Coordinates and implements billing and quality audits based on medical audit standards as promoted by the American Association of Medical Audit Specialists standards, as well as quality audits using TJC Core Measures standards.
    • Supports the manager of the department in the implementation and ongoing monitoring of the clinical audit program.
    • Establishes and maintains good professional rapport with staff while obtaining necessary data.
    • Benchmarks various departments across Memorial Hermann both internally and externally using various financial and operating statistics.
    • Develops methods and strategies for testing the integrity of newly deployed clinical programs.
    • Assesses new material risks, both financial business and compliance risks, making recommendations and implementing changes to ensure Memorial Hermann’s interests are protected and exposure is minimized.
    • Prepares written reports and oral presentations for various committees and executive personnel including audit reports identifying trends or gaps in practice to effect change.
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