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RN Claims Quality Auditor

Company: University of Arkansas for Medical Sciences
Location: Little Rock
Posted on: December 4, 2019

Job Description:

Job Details Company Overview The Claims Quality Auditor, under the general guidance of the Hospital Billing Services manager, is responsible for the review of revenue against third-party billing guidelines and acts as the clinical expertise for questions about charging and clinical practices. The Claims Quality Auditor provides guidance for all staff in HBS regarding charging and clinical practices and acts as liaison with clinical departments regarding charging issues, questions or practices, as they relate to clean claims generation. The Claims Quality Auditor supports the charge capture process for global and research accounts. The University of Arkansas for Medical Sciences (UAMS) has a unique combination of education, research, and clinical programs that encourages and supports teamwork and diversity. We champion being a collaborative health care organization, focused on improving patient care and the lives of Arkansans. UAMS offers amazing benefits and perks: - Health: Medical, Dental and Vision plans available for staff and family - Holiday, Vacation and Sick Leave - Education discount for staff and dependents (undergraduate only) - Retirement: Up to 10% matched contribution from UAMS - Basic Life Insurance up to $50,000 - Career Training and Educational Opportunities - Merchant Discounts - Concierge prescription delivery on the main campus when using UAMS pharmacy Salary offered commensurate with experience Responsibilities The RN Claims Quality Auditor is pivotal to the staffing of the Revenue Support team by providing daily and immediate clinical expertise to charge capture activities. - Supports and resolve edits discovered by the Revenue Guardian within EPIC. - Answers questions from team colleagues or others in HBS about missing charts or the appropriateness of charges. Completes daily work list of bills holding for charge capture issues and meets departmental productivity standards. - Charge Capture - is responsible for working all assigned Revenue Guardian work queues in EPIC. - Evaluates research and determines appropriate charging for accounts that are assigned to the Nurse Audit Queue within 5 business days. - Works with clinical departments to address missing or complete documentation in a professional manner. - Identifies charging patterns and notifies department and/or management so issues can be resolved. - Responsible for working assigned claim edit work queues daily. - Supports and/or completes clinical denials, particularly in the outpatient arena and particularly where the authority of a nurse will be beneficial to the success of the appeal as needed. - Supports/and or completes denials for HBS staff members. Employee investigates the reason of the denial, makes a determination for the appeal and provides denials team member's documentation to support an appeal. - Works with HBS staff to complete and resolve numerous billing requirements, which require clinical expertise, including certain Blue Cross bar code letters, Medicaid pharmacy authorizations, and other third party inquiries, which delay claims adjudication. - Performs charge audits. Employee is expected to assess, analyze and arbitrate external audits within the guidelines of the external charge audit policy. - Works with clinical departments to address missing or complex documentation, particularly in the outpatient arena. - Performs special projects and account reviews as assigned by manager. Employee is able to monitor the progress of all assigned tasks including planning and organizing to accomplish all in a timely fashion. - Works accounts in a thorough, concise and accurate manner. - Accountable to follow all regulations pertaining to charge capture. - Understands clinical processes and can translate into appropriate charges. - Understands billing requirements and can analyze against clinical practices. - Completes and/or supports clinical appeals for outpatient services and assist in issuing inpatient appeals as needed. - Performs audits, as needed, at the direction of HBS leadership. - Other duties as assigned. Qualifications Minimum Qualifications: - Graduate of an accredited Nursing Program with a Bachelors in Nursing. - Valid RN License in the state of Arkansas and one (1) year of Registered Nursing experience in coding, auditing, charge capture, case management or finance. Preferred Qualifications: - Master's degree in Nursing and three (3) or more years of nursing experience in coding, auditing, charge capture, case management or finance. This position is subject to a pre-employment criminal background check and drug screen. A criminal conviction or arrest pending adjudication alone shall not disqualify an applicant except as provided by law. Any criminal history will be evaluated in relationship to job responsibilities and business necessity. The information obtained in these reports will be used in a confidential, non-discriminatory manner consistent with state and federal law. UAMS is an Affirmative Action and Equal Opportunity Employer of individuals with disabilities and protected veterans and is committed to excellence. Physical Requirements Stand: Occasionally Sit: Continuously Walk: Occasionally Bend, crawl, crouch, kneel, stoop, or reach overhead: Occasionally Lift, push, pull, carry weight: 11 - 25 lbs Use hands to touch, handle, or feel: Continuously Talk: Frequently Hear: Continuously Taste or smell: Continuously Read, concentrate, think analytically: Continuously Physical Environment: Inside Office Environment Noise Level: Moderate Visual Requirements: Color discrimination, Depth perception, Far visual acuity, Near visual acuity Hazards: None Recommended skills Claims Appeals Medicaid Auditing Management Research

Keywords: University of Arkansas for Medical Sciences, Little Rock , RN Claims Quality Auditor, Healthcare , Little Rock, Arkansas

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