Compliance Nurse Auditor

Shift: Monday - Friday, 8:00am - 5:00pm
Department: Corporate Compliance

Compensation:

* Base Pay Range: $75,275 - $109,553 per year, based on experience

ABOUT THE JOB

The Compliance Nurse Auditor utilizes clinical expertise, compliance best practices, and critical thinking skills to review encounter-level clinical documentation, coding and billing records, and organizational policies and procedures to monitor and assess compliance with relevant rules, regulations, and requirements, and assists with ensuring revenue integrity.

The Office of Corporate Compliance (OCC) is the hospital's resource for coding and processes to maintain compliance with government regulations. Information obtained, researched, and maintained within the OCC is of a sensitive nature and highly confidential. All professional staff must have high integrity, job knowledge, and practice confidentiality of MU Health Care matters.

ABOUT MU HEALTH CARE

MU Health Care is proud to be named one of Forbes' Best-in-State Employers seven years in a row, and that's largely a result of the incredible culture and team we've built. At MU Health Care, we have an inspired, hard-working and collaborative environment driven by our mission to save and improve lives. Here, we believe anything is possible and rally around solutions. We celebrate innovation and offer opportunities to be a part of something bigger - to have a voice and role in the work that is serving our community and changing the field of medicine.

Our academic health system - the only in mid-Missouri - is home to seven hospitals, including the region's only Level 1 Trauma Center and region's only Children's Hospital, as well as over 90 specialty clinics. Here you can define your career among our many clinical and nonclinical positions - with growth, opportunity and support every step of the way.

Learn more about MU Health Care.

Learn more about living in mid-Missouri.

EMPLOYEE BENEFITS

* Health, vision and dental insurance coverage starting day one

* Generous paid leave and paid time off, including nine holidays

* Multiple retirement options, including 100% matching up to 8%and full vesting in three years

* Tuition assistance for employees (75%) and immediate family members (50%)

* Discounts on cell phone plans, rental cars, gyms, hotels and more

* See a comprehensive list of benefitshere.

DETAILED JOB DESCRIPTION

Evaluates clinically related revenue integrity activities through routine audits, ad hoc clinical audit requests, and answering questions. Assesses encounter-level clinical documentation for relevant compliance matters such as medical necessity, documentation, appropriateness of clinical documentation, and integrity with account charging, coding, and billing.

Performs assigned audits of medical records, reviews hospital and professional charges and documentation, and ensures compliance with regulatory requirements. Plans and presents audit and investigation results to departmental leadership to discuss findings and recommendations.

Plans, conducts, and completes reviews in other areas of compliance and related operations as identified in the risk assessment process. Works closely with revenue cycle, physicians, and other key management personnel throughout the system to improve coding, billing, and clinical documentation compliance.

Analyzes clinical documentation and makes recommendations to promote, maintain, and/or improve organizational compliance, including providing education to departments, leadership, and providers.

Investigates compliance matters and collaborates with department leaders and staff to provide guidance on compliance requirements and relevant findings.

Provides training and acts as a resource to physicians, non-physician providers, support staff, administration, and other personnel on compliance with federal and state regulations and guidelines.

Identifies and provides feedback regarding missing, incomplete, unclear, or conflicting clinical documentation.

Collates findings and recommendations into compliance reports which are distributed to departmental and organizational leadership.

Assists with managing data, data analytics, and information systems for the Office of Corporate Compliance (OCC). This includes building an understanding of MU Health Care information systems, uses, and how the OCC can utilize the information for ongoing risk assessment, continuous monitoring of key controls and data analysis.

May complete unit/department specific duties as outlined in department documents.

REQUIRED QUALIFICATIONS

Missouri Board of Nursing RN or Nurse Licensure Compact multi-state RN. When primary state of residency changes, compact state RNs must apply under new state of residency within thirty (30) days.

Five (5) years of experience in healthcare or a related field.

Certification in one of the following within two (2) years as a condition of continued employment in this job classification:

--Certified Healthcare Compliance (CHC) by Compliance Certification Board (CCB); or

--Certified Internal Auditor (CIA) by Institute of Internal Auditors (IIA); or

--Certified Fraud Examiner (CFE) by Association of Certified Fraud Examiners (ACFE); or

--Certified Professional Medical Auditor (CPMA) by American Academy of Professional Coders (AAPC); or

--Certified Professional Compliance Officer (CPCO) by American Academy of Professional Coders (AAPC); or

--Certified Professional Coder (CPC) and Certified Professional Biller (CPB) by American Academy of Professional Coders (AAPC).

PREFERRED QUALIFICATIONS

Master's degree.

Three (3) years of experience using electronic medical records.

Experience with Cerner.

Additional license/certification requirements as determined by the hiring department.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met with or without reasonable accommodation. The performance of these physical demands is an essential function of the job. The employee may be required ambulate, remain in a stationary position and position self to reach and/or move objects above the shoulders and below the knees. The employee may be required to move objects up to 10 lbs.

Equal Employment Opportunity

The University of Missouri is an Equal Opportunity Employer.

The University of Missouri is an Equal Opportunity Employer.