Job Description
Medical Center: Metrohealth Medical Center
Department: Gen Counsel Claims/risk Mgt
Employee Status: Active Full-Time
Work Schedule: DAY SHIFT
Work Hours: DAYS / MON - FRI VP#: WW 1 2009 **REPOST**
Job Summary:
Under the direction of the Compliance/Risk Officer oversees auditing and monitoring of MHS records for compliance with applicable billing rules and regulations. Responsible for assisting in conducting audits of Medical Charts for professional, technical billing and medical necessity requirements by developing and following monitoring procedures. Evaluates charting to determine if documentation includes requirements for compliance and billing including but not limited to: medical necessity, care plans, orders, etc. In conjunction with Compliance Monitors, care management staff and Medical Record coders determines if proper CPT, ICD-9, DRG and revenue codes have been selected and assigned. Performs random audits of physician coding/documentation, and/or monitoring of coding and billing activities to ensure compliance, billing, and system standards are met. Ensures compliance with rules promulgated by the Office of the Inspector General (OIG) for entire MetroHealth System in conjunction with the System Compliance/Risk Office. Communicates with external auditors system findings, plans of correction and status of compliance program accomplishments. With the department of Compliance, educates and presents to physician groups, nursing staff, administration and other affected employee groups. Assists in customer service issues upholds the standards of the system-wide customer service program.
Required Qualifications:
Registered Nurse, with current Ohio License
Bachelor degree in Nursing, Business, Health Administration or related field
Strong quantitative and analytic skills
Excellent verbal and written communication skills.
Preferred Qualifications:
Working knowledge of financial accounting and billing procedures
Supervisory experience
Masters degree in business, nursing, public administration or related degree