Senior Clinical Auditor
Memorial Hermann Health SystemAt Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.
Job Summary
Position is responsible for coordinating and implementing multiple billing and quality audits as assigned.Job Description
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.
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 Director of the department in the implementation and ongoing monitoring of the clinical audit program.
Establishes and maintains good professional rapport with insurance companies, physicians and 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.
Assures proper confidentiality and complies with HIPAA guidelines.
Coordinates findings of billing audits with insurance companies as appropriate.
Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.
Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.
Other duties as assigned.