Compliance Nurse Auditor

Compliance Nurse Auditor in Starkville, Mississippi, United States

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Compliance Nurse Auditor Job ID COMPL001214 Job Category: Quality Compliance & Safety Job Type: Part-Time

Facility: Baptist Memorial Hospital Oktibbeha County Location: Starkville, MS

Job Summary

Under the direction of Compliance Officer within Department of Compliance, the Nurse Auditor will be responsible for responding to external audits, including writing appeals, working with Medical Staff, and other staff. The Nurse Auditor will be responsible for the facilitys communication and interactions with CMS Recovery Audit Contractors (RAC) and other third-party auditors. The Nurse Auditor will document information and comments into the facilitys tracking system to ensure audit deadlines are met.

The Nurse Auditor will work with other departments to gather information, conduct internal audits, set forth in the OIG Work Plan, and identify problem areas within the facility where changes to organizational practices, policies, or procedures might be needed to enhance organizational efficiencies and effectiveness. The Nurse Auditor, together with other members of the department, will prepare and monitor Corrective Action Plans, conduct education and training, and monitor for progress toward improved performance and compliance.

Other duties include conducting audits to identify problems and assisting the CFO as needed with Healthgrades MACRAMIPS data collection analysis and ultimately educating physicians for improvement.

Qualifications

1. Bachelors degree in nursing from an accredited program required.
2. Masters Degree in nursing, business, or other healthcare-related field preferred.
3. Current Mississippi Registered Nurse License.
4. Relevant experience in a hospital setting.
5. Strong knowledge of state and federal law and regulations.
6. Understanding of CMS coverage and payment methodologies.
7. Excellent oral and written communication skills.
8. Advanced computer proficiency.
9. Excellent organizational skills and attention to detail.
10. Coding experience preferred.
11. Previous audit experience preferred.
12. Knowledge of InterQual and Principles of Managed Care preferred.

Equal Opportunity

Baptist is an equal employment opportunity employer and prohibits discrimination based on an individuals race, color, religion, national origin, pregnancy, sex, age, handicap, disability, physical, visual, or mental creed, marital, and veteran status, genetic information, or any other category protected by federal or state law, with respect to all aspects of the employment process, including recruitment, selection, placement, promotion, wages, benefits, and other terms and conditions of employment.

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