• Account contract to acquire all itemized billing and medicals needed
• Complete pre-screens and communicate results to accounts
• Complete audits, audit reports and billing
• Maintain account communication required to obtain records and approvals
• Process pre-screens and assigns audits
• Complete Hospital Bill Audits on a self-supervised basis
• Orient and train new Hospital Bill Audit contractors
• Edit reports and billing sheets
• Communicate with accounts on audit outcomes
• Frequent interaction with clients
• Maintain records of audits received and processed
• Other duties as assigned

• Proficient computer skills
• Must be a team player
• Ability to work independently and make decisions
• Excellent verbal, written and interpersonal communication skills. Must be able to communicate effectively with all levels of staff.
• Excellent problem solving and analytical skill

• Unrestricted State Registered Nurse License
• Associate Degree or Bachelors of Science in Nursing
• 3-5 years clinical experience
• 1-2 years of hospital bill audit or workers’ compensation experience preferred

E-mail  resumes to: MA.HR@mcmcllc.com; (p) 617-375-7700

4/16/08

Clinical Auditor at Palmetto Health
This position requires the execution of clinical, operational and investigative audits to ensure the reliability and integrity of information, compliance with policies and regulations, the safeguarding of assets, the economical and efficient use of resources, and established operational goals and objectives of Palmetto Health.

Key Responsibilities:

• Assists Patient Financial Services with resolution of biller and patient inquires regarding charge information, utilizing electronic and hardcopy medical records and applicable financial systems.
• Develops and communicates educational materials to nursing staff for skills fairs, departmental meetings and newsletters. Participates on hospital wide process improvement teams and committees, as needed. 
• Determines compliance with established PH clinical and operational guidelines. Develops recommendations for improvement.
• Assists with the preparation of audit reports for the communication of findings and observations to PH Management and to the PH Board of Directors Audit and Compliance Committee.
• Performs audits, investigations, and other assigned auditing services in accordance with the International Professional Practices Framework of Auditing Standards.
• Prepares organized and accurate work papers, ensuring documentation clearly supports the conclusion regarding each audit objective, utilizing automated work papers. 
• Performs medical record and bill audits as deemed necessary, recognizing billing patterns and creating corrected bills for both concurrent and retroactive audits. Subsequently, communicates results to CASD management and to clinical departmental management as well.
• Serves as a defense for PH charge systems and documentation for claims reimbursement with external payment recovery auditors.
• Monitors electronic claims data. Monitoring billing and documentation patterns and initiating corrective action when necessary.
• Actively participates in integrated audits with internal audit and corporate compliance staff; interjecting clinical expertise for completion of and adding value to comprehensive audits.

Requirements:

• Education: Graduate of School of Nursing that results in certification as an RN
• Experience: At least 5 years of hospital nursing (Acute care settings preferred)
• Licensure, Registry or Certification Required: RN
• Special Training: Must possess excellent communication skills, written and oral. Must be able to think analytically, independently and objectively. Must be able to use Microsoft Word and Excel. Electronic medical record experience is preferred.

Palmetto Health offers competitive salaries, excellent benefits and a rewarding work environment. EOE.

Search all of our open positions and apply online at www.palmettohealth.org.

Contact:
Andrea Harrelson
Phone: 803-296-3804
Email:  Recruiter7@palmettohealth.org