RN-Clinical Auditor Manager, Care Transformation

Company: SSM Health
Location: Saint Louis
Posted on: September 30, 2024

Job Description:

Seeking a seasoned RN-Clinical Auditor Manager to lead auditing, monitoring, and reporting efforts for Care Transformation operations, ensuring compliance with regulatory requirements and standards.


Job Highlights:

• 
  
• 7 years of relevant experience in clinical auditing required
  
• Experience and knowledge of inpatient/acute Case Management ideal
  
  
  
  Job Responsibilities:
  
  • 
    
  • Creates and maintains auditing tools, procedures, and reporting for Care Transformation operations
    
  • Performs operational and compliance audits adhering to regulatory requirements
    
  • Reviews patient medical record documentation and compares against medical bills, claims, and revenue reports
    
  • Participates in training and utilizes auditing data to improve risk adjustment measures and denial management processes
    
  • Ensures compliance with government and billing guidelines
    
  • Enhances net revenue by splitting charges and improving claim submissions
    
    
    
    Requirements:
    
    • 
      
    • Graduate of accredited school of nursing or education equivalency for licensing
      
    • 7 years of relevant experience in clinical auditing
      
    • Illinois Registered Professional Nurse (RN) licensure
      
    • Missouri Registered Nurse (RN) licensure
      
    • Oklahoma Registered Nurse (RN) licensure
      
    • Wisconsin Registered Nurse (RN) licensure
      
      
      
      Benefits:
      
      • 
        
      • Paid Parental Leave
        
      • Flexible Payment Options
        
      • Upfront Tuition Coverage
        
        

Keywords: SSM Health, Saint Peters , RN-Clinical Auditor Manager, Care Transformation, Executive , Saint Louis, Missouri