Clinical Quality Assurance Nurse Auditor

Requisition ID
2017-2301
# of Openings
1
Category
Operations
US-CA-Redding

Overview

Looking to transition away from bedside care? Apply your clinical experience in an administration role?

 

The Registered Nurse Auditor is responsible for the audit of the hospital bill line item charges by reviewing patient medical records and matching the items to the Physician Order sheets or the OPO Coordinator orders in the hospital medical record. This position requires consistent availability to staff members and assists management with special projects when necessary. The position reports to the Manager of OPO Review Services.

 

Someone who is passionate about compliance and quality assurance Monday through Friday and likes having their weekends and evenings free. While we also in believe weekends, we truly believe in our service and apparently a lot of insurance companies do as well as we have shown tremendous growth over the last 8 years and are now proud to say that we’re a global company.

 

ExamWorks provides competitive compensation, benefits, professional development, personal wellness and recognition.

 

Responsibilities

ESSENTIAL DUTIES AND RESPONSIBILITIES TO PERFORM THIS JOB SUCCESSFULLY INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING:

  • Reviews and audits line item bills against medical records determining accuracy, and identifying any discrepancies between the bill and documented medical records.
  • Reviews all data to identify recovery opportunities based on each client's specifications.
  • Contacts appropriate person to recover any missing documentation or verify charges.
  • Communicates problems identified in the audits to management and assists in making recommendations for improvements.
  • Prepares an itemized audit summary sheet and submits to data entry department for entry.

To perform the job successfully, an individual should demonstrate the following competencies:

  • Follows instructions; Responds to managements directions; Completes all work assigned by the Manager of OPO Review Services.
  • Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Monitors own work to ensure quality is met.
  • Must demonstrate effective communication skills by conveying necessary information accurately; listening effectively and answering questions when needed.
  • Includes the appropriate management in decision-making process.
  • Must be able to prioritize work activities and use time efficiently.
  • Must be able to demonstrate team behavior and must be willing to promote a team-oriented environment.
  • Assesses own strengths and weaknesses; Pursues training and development opportunities; Strives to continuously build knowledge and skills; Shares expertise with others.
  • Adapts to change in work environment; Ability to deal with change, delays, or unexpected events
  • Demonstrates reliability by arriving to work on time and by abiding by the attendance policy.
    • Excellent interpersonal skills
    • Must be highly motivated and able to work independently
    • Able to identify, define and explain day-to-day problems and solutions. 

Heather.perry@examworks.com

Nurse

RN

LVN

ER

Emergency Room

ICU

Qualifications

EDUCATION AND/OR EXPERIENCE

Bachelor degree in nursing or related field; or minimum five years related experience; or equivalent combination of education and experience. Experience with medical terminology, medications, medical specialties and treatment protocols required. Experience in the insurance industry preferred.

 

CERTIFICATES, LICENSES, REGISTRATIONS

Registered Nursing license required.

Would consider an Licensed Vocational Nurse with strong clinical background.

 

QUALIFICATIONS 

  • Must hold and maintain an unencumbered Registered Nursing license with BSN or equivalent work experience.
  • Must have strong knowledge of medical terminology, anatomy and physiology, treatment protocols, medications and laboratory values.
  • Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages.
  • Must be a qualified typist with a minimum of 40 W.P.M.
  • Must be able to operate a general computer, fax, copier, scanner, and telephone.
  • Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
  • Must possess excellent skills in English usage, grammar, punctuation and style.
  • Ability to follow instructions and respond to upper managements’ directions accurately.
  • Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
  • Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
  • Must be able to work independently, prioritize work activities and use time efficiently.
  • Must be able to maintain confidentiality.
  • Must be able to demonstrate and promote a positive team -oriented environment.
  • Must be able to stay focused and concentrate with frequent interruptions.
  • Must be able to work well under pressure and or stressful conditions.
  • Must possess the ability to manage change, delays, or unexpected events appropriately.
  • Demonstrates reliability and abides by the company attendance policy.
  • Must maintain a professional and clean appearance at all times consistent with company standards.

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