Compliance Specialist - Nurse Auditor
University of Iowa

The University of Iowa Hospitals and Clinics Department of Finance and Accounting Services is seeking a Revenue Integrity Clinical Nurse Auditor to conduct audit activities to ensure appropriate revenue management, charge capture, claims production, coding integrity, and documentation. This position provides education to applicable leadership, implementation support and serves as a liaison to UI Health Care staff as it relates to chart audit issues. As part of the Revenue Integrity Department, reporting directly to the Revenue Integrity Director, this position has collaborative relationships within Revenue Cycle. Conducts special projects to facilitate revenue management as required.

Responsibilities:

• Identifies charging, coding, or clinical documentation issues and works with ancillary departments to resolve issues and notify appropriate leadership.
• Performs assigned audits by researching documentation, analyzing information, and makes recommendations to improve workflow.
• Leads audit evaluations according to Revenue Integrity Department processes. Meets with departmental leadership to review findings, documentation standards, and recommendations for improvement.
• Responds to desk audit findings with next step recommendations and improvements.
• Perform ancillary service quality assurance reviews and departmental audits and meets with department leaders and staff to inform on documentation findings to increase accuracy and improve charge capture.
• Provides feedback to departments regarding missing, incomplete, unspecific, unclear or conflicting documentation.
• Provides coding, documentation, and compliance guidance as requested.
• Assists and directly provides training and orientation in group settings as well as one-on-one.
• Plans and presents to nursing, physician, and staff regarding processes, updates, and reviews relating to audit findings and regulatory compliance.
• Coordinates with Revenue Integrity Analysts to complete various inquiries by departments to ensure accurate and timely responses.
• Collaborates with the Revenue Integrity team on opportunities to improve and implement front-end process change to support denial prevention.
• Works closely with Denials/Appeals and Coding as needed to bridge and drive results through the revenue cycle.
• Regularly reviews information to identify enhancements to the quality assurance methodology and documentation requirements. Maintains in-depth knowledge of Medicare and Medicaid billing practices, guidelines, laws, and regulations to ensure accurate Medicare and Medicaid billing.
• Remains current with regulation changes and related operational processes.
• An integral part in the development of policies and procedures as they relate to improving processes, strengthening controls, enhancing revenue, and improving cash flow.
• Actively participates in team development, achieving dashboards, and in accomplishing department goals and objectives.
• Performs other duties as assigned.

Required Qualifications:

• Bachelor's degree or equivalent combination of education and experience.
• RN required.
• License to practice nursing in the state of Iowa required by date of hire.
• 5 years of experience in health care including knowledge of government payers and applicable federal and state regulations.
• Excellent written and verbal communication skills.
• Demonstrated proficiency in computer software applications. Must have experience using Microsoft Excel.

Desired Qualifications:

• Experience with Epic's Patient Accounting System.
• Understanding of CPT-4 and ICD-10 coding.
• Experience with medical coding.
• Knowledge of and experience in case management and utilization management.
• Experience with or SQL databases.

Application Process: In order to be considered, applicants must upload resume and cover letter (under submission relevant materials) that clearly address how they meet the listed required and desired qualifications of this position.

Job openings are posted for a minimum of 14 calendar days.

Successful candidates will be subject to a criminal background check. This position is not eligible for University sponsorship for employment authorization. For questions, contact Sharon Walther at sharon-walther@uiowa.edu.

Additional Information

• Classification Title: Compliance Specialist
• Appointment Type: Professional and Scientific
• Schedule: Full-time

Compensation

• Pay Level: 5B

Contact Information

• Organization: Healthcare
• Contact Name: Sharon Walther
• Contact Email: sharon-walther@uiowa.edu

This job has expired.