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Clinical Compliance Auditor RN

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2131 South 17Th Street
Wilmington, NC
Job ID: 10910
Date Posted: Nov 4, 2022

Job Description

Description

About NHRMC

NHRMC, established in 1967 in Wilmington, NC, is recognized as a preeminent healthcare organization focused on leading our community to outstanding health. We have an 855 bed network of hospitals and multi-specialty physician group practices with more than 200 physicians. With a network of primary, specialty, neighborhood clinics and regional medical centers; you will find our culture is the very definition of best in practice. Join us and find out how many ways NHRMC offers you the chance to focus on what really matters - our patients and community.

About the Job

Location: New Hanover Regional Medical Center

Department: Corporate Compliance

Full Time Equivalent: FTE: 1.000000

Work Type: 64 to 80 Hours Pay Period

Work Schedule: STD HRS - Standard-Exe or Office w flex

Exempt from Overtime: Exempt: Yes

What You'll Do

Summary:
The Clinical Compliance Auditor RN examines and analyzes patients’ electronic medical records to confirm medical necessity, appropriateness of services provided, and that documentation supports the services charged and billed. The scope of work generally includes assessing risks, identifying trends, developing and executing appropriate tests of controls, presenting results and recommendations for improvements to management, and preparing audit reports for leadership and the Board of Trustees.
The Clinical Compliance Auditor RN will work with leadership of multiple departments throughout the organization to audit and/or evaluate compliance with state and federal laws, with a focus on the Centers for Medicare and Medicaid Services, and the organization’s policies and procedures to identify deviations and recommend corrective action.
Additionally, the Clinical Compliance Auditor RN conducts follow up and investigations on incident reports regarding patient privacy or security concerns and/or suspicious access identified. Under the leadership of the Compliance/Privacy Officer, the scope of the Clinical Compliance Auditor RN's role includes New Hanover Regional Medical Center, Pender Memorial Hospital, NHRMC Home Care, and Carolina Healthcare Associates.
The Clinical Compliance Auditor RN develops and delivers initial and ongoing compliance and privacy training to the workforce, under the oversight of the Compliance/Privacy Officer.
The Auditor will liaison with Patient Financial Services, Revenue Recovery, Reimbursement, Health Information Management, Patient Access Services, and other departments and external parties to assure accurate claims submission.


Responsibilities:
1. The Clinical Compliance Auditor RN works with multiple departments in the hospital to audit electronic medical records and evaluate compliance with federal rules and regulations with a focus on CMS requirements for reimbursement.
2. The Clinical Compliance Auditor RN assists in developing and implementing audit programs to monitor and identify deviations and recommend corrective actions.
3. The Clinical Compliance Auditor RN collaborates with leadership to ensure effective and efficient corrective action plans are implemented and monitored with documented outcomes for non-compliant trends.
4. The Clinical Compliance Auditor RN issues reports, corrective actions and progress to the Compliance/Privacy Officer, department leaders, and the Corporate Compliance Committee.
5. The Clinical Compliance Auditor RN supports leaders in interpreting payment coverage rules and providing education to improve performance. LEAN methodologies will be applied, as applicable.
6. The Clinical Compliance Auditor RN works with hospital departments to ensure education and implementation of federal rules and regulations, which includes working with physicians, departments, and affiliate organizations to facilitate the accuracy of medical record documentation and facility charges.
7. The Clinical Compliance Auditor RN assists in the periodic assessment of the corporate compliance program and development of annual compliance work plans. The Clinical Compliance Auditor RN ensures timely completion of all audit tasks assigned.
8. The Clinical Compliance Auditor RN tracks, investigates, manages, and mitigates HIPAA Privacy incidents involving inappropriate access and disclosure of protected health information, complaints or breaches, including, but not limited to the coordination of investigations with leadership of respective departments. She/he ensures all reports required under applicable privacy laws and regulations are completed and submitted in a compliant and timely manner, under the direction of the Compliance/Privacy Officer.
9. The Clinical Compliance Auditor RN develops and conducts ongoing privacy and compliance training to the workforce, as well as promotes activities to foster information privacy awareness within the organization, such as privacy assessments, tracers, newsletters, etc.
10. The Clinical Compliance Auditor RN serves as a resource for the organization regarding corporate compliance and privacy, acting under the direction of the Compliance/Privacy Officer.
11. The Clinical Compliance Auditor RN may work with the Accreditation Department to support or assist with regulatory issues by performing audits, tracers, and/or participate in survey readiness.
12. The Clinical Compliance Auditor RN demonstrates standards of performance (ownership, teamwork, communication, compassion) that support patient satisfaction and principles of service excellence.

Position Requirements

Credentials:
Essential:
* Registered Nurse

Education:
Essential:
* Associate Degree

Other information:
1. Education: Graduation from accredited School of Nursing; BSN or bachelor’s degree in a related field or 12 years of experience as an RN required. BSN or bachelor’s degree preferred.
2. Licensure/Certifications: Current licensure as a registered Nurse in North Carolina; Auditing and/or compliance certifications preferred.
3. Experience: Minimum of 5 years nursing experience required in acute care or practice setting. Extensive experience in healthcare revenue cycle, auditing, clinical operations and/or compliance preferred. Knowledge of and experience with EPIC preferred. Strong Skills with Microsoft products (Excel, Word, and Power Point)
Demonstrates standards of performance (ownership, teamwork, communication, compassion) that support patient satisfaction and principles of service excellence.
Performs other duties as assigned.
Individual will possess commensurate combination of education, experience and qualifications.

Other Information

This position description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications which may be required of the employee assigned to the position. Depending on the location of the job, duties may vary. Receipt of the job description does not imply nor create a promise of employment, nor an employment contract of any kind; my employment with the Company is at will.

Consider a career at NHRMC and become part of this award winning team!

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