Providence Health & Services Nurse Auditor Revenue Cycle in California
Providence St. Joseph Health is calling a Nurse Auditor Revenue Cycle to work remotely from one of our footprint states which are inclusive of AK, WA, OR, MT, CA and or TX.
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We are seeking a Nurse Auditor Revenue Cycle who will responsible for providing a patient focused, standardized, compliant, sustainable revenue cycle that will support Providence in meeting financial objectives.
Perform medical necessity audits, analyze audit results and report findings to promote and improve compliant processes.
Assists in the research and coordination of compliance related information for the compliance program.
Provide recommendations to align with best practices.
Educate ministries on regulatory procedures to maintain compliance and integrity of the revenue cycle.
Serve as Subject Matter Expert on multiple processes and procedures to assist management with projects relating to the Compliance program.
In this position you will:
Serve as a resource for local ministries.
Assess and provide recommendations on tools, training, education, organizational structure and process improvements related to clinical documentation and case management.
Develop, monitor, and report key measurements and trends to ORC Compliance Leadership.
Collaborate with facilities to identify minimum specifications and/or processes each needs in place to support compliant and accurate clinical documentation that supports medical necessity and other regulatory requirements.
Collaborate with facilities to identify and develop needed resources to provide education and evaluation of clinical documentation.
Collaborate with clinical leadership to develop a proactive approach to meeting clinical documentation standards.
Interpret and communicate regulatory standards and their implications to clinicians and key internal constituents.
Collaborate with facilities to develop solutions to support clinical documentation improvement due to audit findings.
Evaluate and audit medical records for accuracy and compliance to current work standards in support of regulatory appeals.
Ensure business processes and workflows are optimal and deliver expected business results.
Proactively identify opportunities to improve business results and performance against goals.
Communicate and document recurring problems, including business impact and possible resolutions.
Submit all completed regulatory audits along with the required supporting documentation as appropriate.
Use a consultative style to work with business units to improve business processes.
Reduce reporting variations by working with business office departments to identify issues impeding accurate, timely and relevant reporting.
Escalate issues proactively, using sound judgment to determine the need for escalation.
Monitor, track and report on the quality of daily operational performance, including accuracy, compliance, and achievement of service level agreements.
Maintain key quality assurance statistics; identifying and reporting trends and anomalies.
Work with department managers to determine recommendations designed to improve business outcomes.
Review recommendations as subject matter expert to ensure recommendations are sustainable.
Work with Internal Audit, providing audit related assistance as needed.
Participate in a culture where fellow team members are focused on both individual and team targets; where metrics are understood, monitored and results celebrated.
Identify and communicates major issues and service failures that impede success following the chain of command in a calm and respective manner.
Keep informed concerning third party payor regulations and compliance issues and ensures that physician admission orders are followed and charges for patient treatment are compliant with current methods and regulations.
Keep current with the ministries newly offered medical services, techniques, and procedures.
Document charging errors using appropriate charge code to an internal inpatient audit form for data entry.
Investigate medical record and charge entry discrepancies, analyzes information; gathers statistics and makes recommendations for process improvements.
Prepare audit reports and presents findings.
Research patient charge inquiry concerns and follows up to appropriately resolve.
Maintain HIPAA standards regarding confidentiality of highly sensitive patient information and performs all activities with discretion.
Serve as a resource person regarding patient charges and the internal audit process for staff within the revenue cycle departments and other ministry departments.
Provide ongoing education for ministry departments and charging personnel.
Work with ministry departments in the Internal Charge Audit process to advance the ministry’s goal of continuous quality improvement.
Coordinate third party audits and cooperates with payors for reconciliation.
Support the appeals process for third party payor denials to obtain optimal reimbursement.
Embrac the mission, core values, and philosophy of Providence Heath and Services and affiliates.
Compliance results communicated accurately and timely.
Customer service standards met or exceeded.
Medical necessity documentation risks reported accurately and timely.
SME'S on multiple processes and procedures to assist the management with projects related to the compliance program.
Required qualifications for this position includes:
Bachelor's Degree Nursing -OR- equivalent combinations of education and experience may be considered in lieu of the BSN degree requirement
5 years Clinical experience in an acute care setting
3 years in a leadership role
Strong background in the use of IT for documentation
Experience working with physicians to accomplish specific objectives
Experience in a high production, deadline-oriented professional work environment requiring multi-tasking, flexibility, and self-directed work
Proven track record in identifying and resolving inefficiencies in business processes
Track record in building and maintaining regular communication and feedback channels
A track record in organizing and planning with demonstrated ability to effectively manage time and achieve results in a fast paced environment
Nursing Certification/Licensure required in a state in which Providence is located
Preferred qualifications for this position includes:
Case Management Experience
Regulatory Appeals Experience
Experience in a multi-hospital and/or integrated healthcare system
Familiarity with Revenue Cycle processes
About the department you will serve.
One Revenue Cycle (ORC) is the name adopted to reflect the Providence employees who work throughout Providence in revenue cycle systems and structures in support of our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. ORC’s objective is to ensure our core strategy, One Ministry Committed to Excellence, is delivered along with the enhanced overall patient care experience (know me, care for me, ease my way) by providing a robust foundation of services, operational and technical support, and the sharing of comprehensive, relevant, and highly specialized revenue cycle expertise
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Nursing Informatics
Other Location(s): Montana, California, Washington, Oregon, Texas, Alaska
Req ID: 317301