Career Opportunities

This service is available to employers and our members but is not an AAMAS endorsement of the employers or positions advertised. Positions are posted for 3 months at $200. If you wish to place an advertisement on this page please email your position description to lpocsik@resourcenter.com

RN Auditor - St. Petersburg, FL

We believe every team member has the power to make a difference in the lives of others—It’s who we are. As an organization focused on outstanding service, Bayfront Medical Center strives to ensure all aspects of the patient experience are well above expectations. Our combination of expert medical care, advanced technologies, and genuine commitment to treating our patients with warmth and respect ensure all the best patient outcomes and experiences.

We are seeking a skilled and talented
RN Auditor
in Revenue Integrity Department
St. Petersburg, FL

If you have an Associate degree in nursing or bachelors degree in healthcare, hospital, or business administration. Minimum of 1-2 years comprehensive healthcare auditing experience or equivalent. Familiarity with hospital charging, coding and medical terminology. Knowledge of healthcare regulations, reimbursement methodologies, ICD-9 and CPT coding, Health Insurance Adjudication or Underwriting. Proficient with excel spreadsheets and you are professional, highly organized, self-motivated, detail-oriented and energetic team player who can also work independently this is a great opportunity for you.

Job Requirements

The ideal candidate will perform specialized administrative duties pertaining to hospital billing and reimbursement activities, utilizing a knowledge of both nursing and administrative practices; apply knowledge of hospital services, health care treatments and medical terminology in order to audit the charges on medical bills, both retrospectively per eligible audit request and prospectively as part of Revenue Integrity efforts; performs managed care defense audits and under/over charge audits; reviews charge-related patient grievances; reviews denied charges, recommends appeals and/or facilitates the resolution of root causes where appropriate; collaborates with Case Management for medical necessity reviews; determines if denied appeals should be forwarded to UR for additional level of appeals; reviews patient records requested by RAC, MPI, and other government entities, preferably before records have been submitted; communicates audit findings to various parties and works closely with a variety of internal departments, external parties or individuals to resolve disputes; follows up with compliance regarding recoupment and claims rebilling. Ability to perform financial analysis with respect to charge auditing; analytical and problem solving skills and knowledgeable of CPT and DRG coding and charge master required.

Behind every patient success is the dedication of a unique team of skilled and talented individuals who help make Bayfront Medical the number one Trauma center in Pinellas County. If you share our passion and customer service goals, join us and put your beliefs into practice! Apply today: www.bayfront.org, eoe.

Become a fan: www.facebook.com/careersatbayfront.

Posted February 20, 2012

Medical Charge Capture Specialist
Vanderbilt University - Nashville, Tennessee

The Charge Capture Specialist position for the VUMC Department of Charge Integrity will work directly with the Assistant Director of Charge Integrity. The position will be responsible for performing routine and special project analysis to assure the accuracy and completeness of charges captured for insurance and patient billing of inpatient and outpatient hospital services.

Key Functions and Expected Performances

Performs analysis of charges generated from ancillary subsystems to the insurance claim and/or patient statement to verify the accuracy of charges.
Performs analysis of charges that correlate with documented medical/nursing interventions.
Identifies appropriate charges on the patient bill, utilizing documentation from the medical record.
Verifies and resolves discrepancies by utilizing the tools and resources available, e.g. Medipac/Epic billing systems, medical record documentation, Charge Master data, Patient Accounting/VMG Business Offices and/or contacting the appropriate internal department.
Identifies deficiencies or discrepancies in nursing and/or physician documentation that affects billing and notifies the originator of the incorrect documentation to allow for proactive improvements related to charge capture.
Demonstrates and applies the various reimbursement methodologies (DRGs and APCs) to secure optimal reimbursement. Understands the relevance and impact of correct units, modifiers on reimbursement under the various methodologies.
Remains knowledgeable about CMS and Fiscal Intermediary medical necessity guidelines and their impact on reimbursement.
Takes an active role in addressing medical necessity issues that impact the quality of care and hospital reimbursement.
Coordinates work and communicates and proactively resolves critical charge capture and coding issues to multiple management lines including but not limited to: Medical Information Services, VMG Coding and Charge Entry, Patient Accounting/VMG Business Offices, Department of Finance/Patient Care Center Financial management team, VUMC Clinical Administrators, Charge Master/Accuracy Specialists and Information Management personnel.
Collaborates with the clinical department administrators in the development and implementation of educational activities related to charge capture improvement projects.

Additional Information:

This is a full-time; exempt position. No traveling is required.

Salary is commensurate upon years of education and experience.

Our benefits package:

Health, dental, vision and life insurance
Long term disability
Accidental Death and Dismemberment insurance
Company matched 403(b)
Tuition reimbursement
Paid vacation
Corporate casual dress
Relocation Assistance

Background screens will be performed and education will be verified prior to employment. Please be prepared to provide required information and/or documentation.

Vanderbilt is a smoke-free workplace in compliance with the Non-Smoker Protection Act, Tennessee Code Annotated 39-17-1801-1810. In accordance with that law and Vanderbilt policy, smoking is prohibited in all buildings on Vanderbilt property and on the grounds of the campus with the exception of designated outdoor smoking areas.

Vanderbilt is an equal opportunity, affirmative action employer

Basic Requirements

This position requires a Bachelor’s degree with a minimum of 4 years of relevant experience or the equivalent. Emphasis in Business Administration, Accounting, Healthcare Administration, Nursing, Health Information Management or other related healthcare concentration area preferred.

Required Experience and Skills

Knowledge and understanding of hospital revenue cycle operations (registration, charge capture, health information management, claims, payment posting).
Knowledge of regulatory publications, how to access and interpret.
Working knowledge of medical terminology.
Hospital billing experience and knowledge of UB-04’s
Solid oral and written communication skills.
Excellent analytical and problem-solving skills.
Experience with Microsoft Office (Word, Excel, PowerPoint).

Preferred Qualifications and Skills:

Medical auditing and/or coding experience of hospital inpatient and outpatient claims and professional certification as a CPC-H or CMAS (Certified Medical Audit Specialist)
Candidates with advanced business or healthcare related degrees and professional work experience in revenue cycle operations and/or clinical operations
Knowledge of government and commercial payer requirements to ensure accurate and compliant charging and billing of hospital inpatient, outpatient, surgical and ancillary services
Knowledge of CPT, HCPCs, and revenue codes
Knowledge of APC, fee for service, and DRG payment methodologies
Experience in utilizing computerized data analysis techniques/tools to identify charge capture issue
Working knowledge of hospital clinical operations and related charge capture processes
Working knowledge of hospital billing processes and key revenue cycle concepts

Submit resumes to:
richard.le@vanderbilt.edu

Posted February 16, 2012

Director, Compliance (Operations/Data Analytics)
MedStar Health
Columbia, MD

DIRECTOR, COMPLIANCE OPERATIONS

Assists the Vice President and Compliance Officer with the oversight and maintenance of a high-quality, effective, best practices compliance program to prevent and detect violations of law and other misconduct and to promote ethical practices and a commitment to compliance with applicable federal, State, and local laws, rules, regulations and internal policies and procedures. Requires a Bachelor's degree, JD preferred and 6 years of progressively responsible experience in compliance, risk management, internal audit or a legal department in a healthcare setting (extensive knowledge of healthcare fraud and abuse laws, regulations, and guidance. Supervisory experience required); OIG, DOJ, or other government investigative or enforcement experience a plus.

DIRECTOR, COMPLIANCE & DATA ANALYTICS

Directs the compliance and data analytics operational activities managed by the Office of Corporate Business Integrity relating to compliance with federal and state laws, regulations, rules, and processes and will oversee the data analytics program and risk assessment-related process. Requires a Bachelor's degree (preferably in a healthcare related field); Master's degree preferred and 4 years experience in claims data mining and analysis, auditing, or risk management (extensive knowledge of documentation and coding laws,regulations,and rules). Supervisory experience also required.

MedStar Health is the largest healthcare system in the Baltimore/Washington region with more than 25,000 employees and 5,000 affiliated physicians. We offer an exceptional professional environment for motivated individuals who share our high quality standards. In addition, we’ve been named among the “Best Places to Work” by the Baltimore Business Journal and rated 5% over the national average for healthcare companies in employee satisfaction.
Join us!

To learn more and apply, visit:
http://tinyurl.com/73eazm2
EOE

Posted February 8, 2012

Medical Audit Specialist - Houston, TX

JOB SUMMARY

The Medical Audit Specialist conducts independent clinical chart audits and billing compliance monitoring reviews to assist Business Practices and Internal Audit personnel in the performance of their auditing and monitoring activities of the hospital's medical record coding, documentation, and billing practices. These activities are designed to evaluate whether the business processes, coding documentation and billing practices are in compliance with applicable Federal, State and third party payers rules, guidelines and regulations. The Medical Audit Specialist reports to the Director, Business Practices with additional direction by the Director, Internal Audit.

DUTIES AND RESPONSIBILITIES

Performs assigned medical record audits, billing reviews, or compliance-related projects for the Directors of Business Practices and Internal Audit.
Reviews and analyzes claims data and medical records information to determine the accuracy of payment, appropriateness of coding, and adequacy of supporting clinical documentation.
Evaluates whether the clinical documentation contained within the patient chart supports the items and/or services coded and billed in compliance with applicable laws & regulations, coding guidelines and coverage policies.
Identifies opportunities for improvement and develops formal audit recommendations to address charge errors, procedural weaknesses, system flaws, coding inaccuracies, or other items of non-compliance.
Assists the Business Practices Director with the development, oversight, and monitoring of compliance programs at Methodist. Assists with special compliance projects or training & education efforts.
Utilizes a risk-based audit approach and establishes preliminary scope of reviews, incorporates data-mining and analysis where appropriate.
Provides oral and written communication of audit notifications, objectives, status, results and follow-up to auditees and management.
Develops and maintains professional skills and knowledge through attendance at relevant educational programs, participation in professional organizations and review of current literature.
Provides department management with periodic status reports, at least monthly, of progress against the annual audit plan and other projects.

Experience - External:

EDUCATION REQUIREMENTS

Registered Nurse (RN), Bachelors of Science in Nursing (BSN), Bachelor's degree in health information management, or health related field.

PREFERRED CERTIFICATIONS

Prefer an active certification in one or more of the following:
RHIA (Registered Health Information Administrator),
RHIT (Registered Health Information Technician),
CPC-H (Certified Procedural Coder),
CCS (Certified Coding Specialist) or
CMAS (Certified Medical Audit Specialist).

EXPERIENCE REQUIREMENTS

Three to five years of recent experience in clinical operations, medical record auditing, coding, billing, utilization review or reimbursement. Direct experience in medical chart review for inpatient providers is required.

SPECIAL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED

Demonstrates subject matter expertise in the areas of clinical documentation standards, coding guidelines, Medicare coverage policies, third party payer reimbursement rules, and medical terminology.
Working knowledge of medical diagnosis, treatment protocol, and current Federal and State healthcare rules and regulations.
Thorough understanding and knowledge of health care legal and regulatory practices and internal control systems/procedures.
Successful project management skills - ability to work under pressure and multi-task competing priorities within established time constraints.
Demonstrates effective verbal and written communication skills.
Demonstrates a positive, helpful and supportive attitude and demeanor.
Professional handling of confidential/sensitive information requires strict confidentiality with no compromise, as well as honesty and integrity.
Proven ability to analyze information and situations and to identify issues.
Must be able to deal with difficult issues, maintain objectivity, use good judgment, and envision outcomes when making decisions.
Performs at a level requiring minimal direct supervision.

WORKING ENVIRONMENT

Normal office conditions and environment, some local travel required to Methodist Hospital locations, occasionally required to work more than 40 hours per week.

EXPERIENCE REQUIREMENTS

Prior nursing (hospital experience) and auditing experience, 5+ years preferred.
CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED.
Registered Nurse (RN).

SPECIAL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED

Strong customer service and analytical skills required.
Understanding of insurance and billing requirements.
Strong PC skills, specifically proficient with MicroSoft Office Suite.
Excellent verbal and written communication skills in the English language.
Must be reliable and dependable to come to work consistently.

Please apply here - http://www.methodisthealthcareers.com/profile/2594341/

If you have any questions please email me – cmendoza@tmhs.org

Posted January 25, 2012

DCS Healthcare Services - Lathrop, California
A Performant Company

RNs and RN Certified Coders

SIGN-ON BY JANUARY 31, 2012 AND RECEIVE UP TO A $1500 BONUS.

RNs for the position of Medical Review Nurse

Perform medical chart reviews for Medicare compliance, QA audit reviews, and assist in new audit issues and input new issue packages together, interpret complex cases with multiple variables, and assist in strategic planning, preparation, and delivery of outreach materials.

An active, unrestricted RN license in good standing
3 years diversified nursing experience providing direct care in areas such as inpatient or outpatient settings, Rehab, SNF, etc
In-depth knowledge of ICD-9, DRG, CPT coding, HCPCS, revenue codes, coding clinic, and medical terminology
Prefer Nurses with some coding credentials, CPC, RHIT, etc

RNs Certified Coders for the position of Medical Review Nurse Auditor

Perform retrospective claim audit reviews for medical necessity, DRG, and clinical validation in both inpatient and outpatient settings.

An active, unrestricted RN license in good standing
3 years diversified nursing experience providing direct care in areas such as inpatient or outpatient settings, SNF, Rehab, etc
Active Certification as an RHIA, CCS, RHIT, CPC, CPC-H, CPC-P, or CCS-P with minimum 3 years experience with impatient DRG coding
In-depth knowledge of ICD-9, DRG, CPT coding, HCPCS, revenue codes, coding clinic, and medical terminology
Experience performing utilization reviews
Knowledge of CMS rules and regulations

JOIN A 35+ YEAR OLD WELL ESTABLISHED COMPANY
EXELLENT SALARY – EXELLENT BENEFITS - TEAM ENVIRONMENT
MONDAY THROUGH FRIDAY SCHEDULE

FMI www.performantcorp.com
Submit resumes to:
Kmarshall@performantcorp.com
Equal Opportunity Employer

Posted January 25, 2012

Certified Medical Audit Specialist - Austin, Texas

Research & Planning Consultants, L.P. has an immediate opening in its Austin Texas office for a full-time or part-time employee to review medical bills and medical records as part of our growing litigation support practice. RPC provides:

Life care plans for personal injury litigation.
Expert analysis in medical fee disputes.
Lost profits analysis in litigation involving health care providers.

The full-time position is a salaried position with a competitive salary, full benefits including group health and life insurance, retirement plan, paid leave and opportunities for professional development.
The ideal applicant will have the following qualifications:

Minimum of a bachelor’s degree.
Currently licensed Registered Nurse or currently certified as a medical coder by AHIMA (RHIT, RHIA, CCS, CCS-P) or AAPC (CPC).
Currently certified by AAMAS as a Certified Medical Audit Specialist.
Two or more years prior experience in medical billing or medical bill review.

The ideal applicant will be able to work from our Austin office. We will consider applicants who live elsewhere and would work over the Internet.

RPC currently employs a Certified Life Care Planner. The successful applicant will work with the Life Care Planner and will have the opportunity to earn the certification. There will also be an opportunity to train to prepare Medicare set aside reports.

In 2012, RPC celebrates its 40th year in business. Information on RPC is available on our web site: www.rpcconsulting.com. RPC is an equal opportunity employer. Applicants should provide a current curriculum vita, professional references, and salary requirements to Patsy McReynolds, pmcreynolds@rpcconsulting.com.

Posted January 17, 2012

Project Manager – Coding Compliance

About Sharp HealthCare

Sharp HealthCare is a not-for-profit integrated regional health care delivery system based in San Diego, California. Sharp includes four acute care hospitals, three specialty hospitals and two medical groups, plus a full spectrum of other facilities and services. Sharp’s passion for caring is shared by our 2,600 physicians, including more than 1,000 physicians in our two affiliated medical groups — Sharp Rees-Stealy and Sharp Community Medical Group — and more than 14,000 employees. Together this team is working to make Sharp San Diego’s best place to work, the best place to practice medicine and the best place to receive care. The Sharp Experience is our unique, system wide commitment to transforming health care in San Diego.

Project Manager – Coding Compliance

Apply: http://bit.ly/o5DU6m

Qualifications

Bachelor’s degree preferred.
Certified Coding Specialist (CCS) or equivalent medical coding certification/licensure required.
ICD-10 Certification preferred.
RHIT, RHIA, AHIMA certification or licensure preferred.
Six (6) years’ experience in Health Care Compliance or Health Information Management (HIM) with progressively more responsible job related experience in health care operations required.
Work requires a relatively high level of problem-solving skills to find solutions to difficult human, technical, clinical or administrative problems.
Responsible for managing various projects required.
Ability to supervise the work of a small support staff or outside consultants and/or contracted staff as needed.

Summary
This Project Manager-Coding Compliance is a critical role to meet the Corporate Compliance mission to provide internal Sharp HealthCare customers, including all levels of operating unit and senior management, the Board Audit and Compliance Committee with an independent assessment of the quality of the organization’s internal coding and billing processes, as well as objective and innovative suggestions for continuous improvement.

Develops, implements and maintains a compliance program for coding compliance, including performing random documentation and decoding audits to ensure compliance with coding and billing requirements; manages coding and other compliance related projects and supervises subordinate staff and outside consultants, where and when applicable.

Conducts educational sessions for physicians and coders. Prepares reports on completed audits. Oversees and monitors the implementation of the coding compliance program. Performs documentation and coding validation reviews. Identifies problems and reviews patients charts for accuracy of coding, sequencing and documentation, with particular reference to HIM compliance requirements. Investigates and resolves complex compliance issues. Communicates with regulators to resolve issues. Provide guidance to departments on ways to improve adherence to regulatory requirements.

Manage multiple audit projects assigned to achieve the scope, timing, and objectives of each assignment. Responsible for planning and executing assigned audits to independently review and appraise the organizational activities of coding compliance for all regulatory agencies. Plans and administers educational programs for coding personnel, nursing and ancillary personnel and physicians.

Sharp HealthCare's Corporate Compliance department has received "best compliance practices" awards in the following areas:

"Data Mining and Analytics for RAC Success", awarded by Health Ethics Trust, October 2010
"An Interventional Coding Compliance – Inter Disciplinary Team Approach", awarded by Health Ethics Trust, November 2007.

Location
This position is located in Kearny Mesa, area of San Diego, CA.

Apply: http://bit.ly/o5DU6m

Questions? email: connie.chovan@sharp.com

Physical Requirements
May spend hours sitting at a desk, meeting table or computer terminal. Must be able to hear and speak clearly by telephone. Calmly and professionally respond to frequent deadlines for clients and able to prepare work and presentations on short notice. Ability to manage multiple tasks and deliverables.

Sharp HealthCare is proud to be an Equal Opportunity/Affirmative Action Employer (M/F/D/V).

Each new hire candidate who is offered employment must pass a physical evaluation, urine drug screen and pre-employment back ground checks before starting work.

Keywords: 45530, Project Manager - Coding Compliance, health care, coding, coder, compliance, HIM, AHIMA, CCS, CCP, audits, billing, coding auditor, healthcare, corporate compliance

Posted January 12, 2012

Charge Audit Nurse

When Your Work Moves You

Gwinnett Medical Center is a 553-bed, not-for-profit healthcare network that provides a wide array of high-quality services and facilities to Lawrenceville, Duluth, Johns Creek and the Atlanta area. With roots that go back more than 60 years, Gwinnett Medical Center has hospitals—along with various other support facilities—in Lawrenceville and Duluth. Gwinnett Medical Center–Lawrenceville is recognized as a national leader in single incision laparoscopic surgery and home to a Level II trauma center, while Gwinnett Medical Center–Duluth offers an array of specialty services, including surgical weight management and sports medicine. With more than 4,200 employees and 800 affiliated physicians, we have repeatedly received national recognition for clinical excellence, ranking in the top 5% in the nation for clinical quality. Gwinnett Medical Center is committed to transforming healthcare in our community.

At Gwinnett Medical Center, we care for our employees as much as we do our patients. In this progressive environment, the support of your team and our ongoing development programs give you the opportunity to learn and grow – and to move forward in your career. You’re encouraged to contribute ideas to a responsive leadership team, and you will see first-hand how you make an impact. We’re a growing organization, with state-of-the-art equipment that reinforces your ability to provide a sophisticated level of care.

Charge Audit Nurse

At GMC, our Charge Audit Nurse is part of a team whose primary responsibility is to improve the overall quality, compliance and completeness of charges captured on each patient encounter. This nurse performs detailed concurrent audits of complex patient accounts by comparing the medical records documentation to the charges. This position also performs special audit activities, including defense audits and patient request audits. You will serve as an educational resource to all members of the revenue cycle team on an ongoing basis on issues related to charge capture and charge appropriateness.

A BSN with a current State of Georgia Registered Nurse license and/or five years’ audit experience is required. Must be able to demonstrate working knowledge of multiple reimbursement systems, including PPS. Coding certification or CPC coding course preferred. Understanding of CPT or HCPCS required.

Discover the support and state-of-the-art technology that lets you make the most of your passion for healthcare. For more information or to apply, visit jobs.gwinnettmedicalcenter.orgtoday. EOE.

Move your career forward.
Gwinnett Medical Center

Posted January 9, 2012

Charge Audit Clinician

When Your Work Moves You

Charge Audit Clinician

You will plan, develop and implement staff development functions to promote overall quality, compliance and completeness of charges captured on each patient encounter. In addition, you will function as a clinical resource for revenue integrity charge capture and compliance practices. This is an education/leadership role reporting directly in to the Director of Revenue Integrity.

Requires a Bachelor of Science degree in Nursing with five years’ recent experience in charge auditing. CMAS certification and experience in staff development is preferred.

Discover the support and state-of-the-art technology that lets you make the most of your passion for healthcare. For more information or to apply, visit jobs.gwinnettmedicalcenter.org today. EOE.

Move your career forward.
Gwinnett Medical Center

Posted January 9, 2012

Staff Auditor

Illness is never a game. But that doesn’t mean great victories aren’t possible. That’s why MetroHealth employees do whatever it takes to make a patient well. As one of the largest and most comprehensive health care providers in Northeast Ohio, MetroHealth has proudly served Greater Cleveland since 1837.

Under the direction of the Manager and/or Senior Internal Auditor, you will conduct reviews of assigned organizational and functional activities, evaluate the adequacy and effectiveness of controls over activities reviewed; determine whether areas reviewed are performing their planning, accounting, custodial, or control activities in compliance with management instruction, in a manner consistent with organizational objectives. You will also report audit findings and make recommendations for correcting unsatisfactory conditions and improving operations and reducing costs.

Required Qualifications include:

Bachelor’s degree in Accounting, Finance, or other related Business or operational field.
Minimum one year experience in financial/operational/technology auditing or related industry experience.
Knowledge of PC applications including Word, Excel, and PowerPoint.
Progress towards certification (CPA, CIA, CISA, etc.) and/or Graduate degree in business-related areas.
Excellent oral and written communication skills, including active listening skills and skill in presenting findings and recommendations.
Knowledge of the Standards for the Professional Practice of Internal Auditing and the Code of Ethics developed by the Institute of Internal Auditors
Ability to establish and maintain harmonious working relationships with co-workers, staff and external contacts, and to work effectively in a professional team environment.

Join us and see what’s possible when a great group of people are at the top of their game and always rally around their community, their patients, and each other. At MetroHealth, you’ll find one great team and countless comebacks. To apply for this position, visit www.metrohealth.org/careers. EOE.

Posted January 6, 2012

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