Clinical Auditor Manager
Company: SSM Health
Location: Saint Louis
Posted on: September 28, 2024
Job Description:
Job SummaryAs a Clinical Auditor Manager, you will play a
critical role in ensuring the daily management of auditing,
monitoring of processes, reporting, and outcomes to ensure Care
Transformation is compliant with regulatory requirements and
standards are maintained.Key Responsibilities
- Creates and maintains auditing tools, procedures, and reporting
for all areas of Care Transformation operations: Clinical
Documentation Improvement; Utilization Management and Status
Review; Case Management Standard Work.
- Performs operational and compliance audits adhering to
regulatory requirements.
- Creates and standardizes policies, procedures, and reporting
for all auditing procedures.
- Reviews patient medical record documentation related to
Clinical Documentation Improvement, Utilization Management, and
compares against medical bills, claims, and revenue reports.
- Participates in training of specific area of focus by tailoring
to specific needs identified within auditing findings.
- Utilizes auditing data, along with data analysts/liaisons, to
improve risk adjustment measures and denial management processes
within department.
- Resolves inquiries from internal and external sources to
reconcile accounts accurately and within compliance
guidelines.
- Ensures compliance with government and billing guidelines by
reviewing and splitting or combining claims per clinical/billing
guidelines.
- Enhances net revenue by splitting charges that should be
presented on separate claims to capture entitled revenue.
- Improves claim submissions by reviewing, researching,
resolving, and trending claim issues in a timely
manner.Requirements
- Graduate of accredited school of nursing or education
equivalency for licensing.
- 7 year's relevant experience in clinical auditing.
- REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS: Illinois
Registered Professional Nurse (RN) - Illinois Department of
Financial and Professional Regulation (IDFPR), Missouri Registered
Nurse (RN) Issued by Compact State Or Registered Nurse (RN) -
Missouri Division of Professional Registration, Oklahoma Registered
Nurse (RN) Issued by Compact State Or Registered Nurse (RN) -
Oklahoma Board of Nursing (OBN), Wisconsin Registered Nurse
(RN).BenefitsSSM Health values our exceptional employees by
offering a comprehensive benefits package to fit their needs.We
offer eligible team members one week of paid parental leave for
newborns or newly adopted children (pro-rated based on FTE).Our
voluntary benefit offered through DailyPay provides eligible hourly
team members instant access to their earned, unpaid base pay (fees
may apply) before payday.We provide upfront tuition coverage
through FlexPath Funded for eligible team members.
Keywords: SSM Health, Saint Peters , Clinical Auditor Manager, Executive , Saint Louis, Missouri
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