• Quality Assurance Nurse Auditor 

    Requisition ID
    2018-3606
    # of Openings
    1
    Category
    Operations
    Location
    US-CA-Redding
  • Overview

    Looking for a role that doesn’t require working nights, holidays or weekends? Looking to stay in the nursing world and utilize your clinical background? The Quality Assurance Nurse Auditor (internally known as a Clinical Quality Assurance 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.

     

     

    Responsibilities

     

    • 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. 

     

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    Qualifications

    EDUCATION AND/OR EXPERIENCE

    • Associate degree in nursing or related field; or minimum five years related experience; or equivalent combination of education and experience.
    • Clincial Experience in a Hospital preferred. 
    • Active, unrestricted Registered Nursing or LVN license required.
    • 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.

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