Loading...
Share this Job

Clinical Audit Coordinator Job

Apply now »

Date: Aug 21, 2021

Location: Memphis, TN, US

Company: Methodist Le Bonheur Healthcare

Summary

Responsible for coordinating and monitoring the clinical audit management and appeals process. Serves as a liaison between patient financial services and Case Management, monitoring and reporting identified certification and payer issues. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

Education/Experience/Licensure

 

Education/Formal Training

Work Experience

Credential/Licensure

 

REQUIRED:

Associate’s degree in Nursing (ADN) or related field.

Five (5) years of acute care setting, care coordination, care facilitation, and denials management as a registered nurse (RN).

Registered Nurse (RN) with current license to practice as a professional nurse in the state of employment.

 

PREFERRED:

Bachelor’s degree in Nursing or related field.

Experience with Care Management/Utilization Management software packages.

N/A

 

SUBSTITUTIONS ALLOWED:

N/A

N/A

N/A

Knowledge/Skills/Abilities

  • Positive working relationship and excellent interpersonal skills in working with physicians.
  • Excellent written and verbal communication skills.
  • General PC skills.
  • Effective interpersonal relationship skills.
  • Ability to plan and schedule tasks and to maintain control of own work flow.
  • Ability to communicate information to groups of people in an educational setting.

Key Job Responsibilities

  • Manages and appeals payer and patient clinical audits.  Coordinates clinical audit efforts.
  • Identifies, monitors and reports problematic areas in the charge capture/documentation process, which may impact registration, billing, and reimbursement.
  • Actively participates in Methodist CIP efforts; identifies and communicates areas for improvement in ongoing efforts for quality care; assists in gathering, analyzing, and presenting data in the assigned populations.
  • Demonstrates initiative in identifying and pursuing opportunities for self-improvement and enhancement of professional competency.
  • Demonstrates effective customer relation skills, promotes a positive work environment, and contributes to the overall team effort. Establishes a good working relationship with physicians, clients, and other members of the health care team.
  • Understands, applies, and supports department/hospital policies, procedures, and standards.

Physical Requirements

  • The physical activities of this position may include climbing, pushing, standing, hearing, walking, reaching, grasping, kneeling, stooping, and repetitive motion.
  • Must have good balance and coordination.
  • The physical requirements of this position are: light work - exerting up to 25 lbs. of force occasionally and/or up to 10 lbs. of force frequently.
  • The Associate is required to have close visual acuity to perform an activity, such as preparing and analyzing data and figures; transcribing; viewing a computer terminal; or extensive reading.
  • The conditions to which the Associate will be subject in this position: The Associate is not substantially exposed to adverse environmental conditions; job functions are typically performed under conditions such as those found in general office or administrative work.


Nearest Major Market: Memphis

Job Segment: Audit, Clinic, Nursing, Registered Nurse, Medical Research, Finance, Healthcare