Senior Nurse Auditor

Site: Mass General Brigham Incorporated

 

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

 

 

Job Summary

The Senior Clinical Nurse Auditor has a vital role in a high-profile group tasked with improving revenue results by taking a global view of clinical and financial processes, functions, and interdependencies from the provision of patient care to payment for services rendered. The Senior Clinical Nurse Auditor leads clinical audits to support the organization’s overall revenue integrity by implementing best practice charge capture processes to support the organization’s financial performance and ensure compliance with federal and state regulatory requirements. Under limited supervision from the Manager, Central Audit or other more senior Central Audit/Patient Financial Services leaders, the Senior Clinical Nurse Auditor is responsible for the facilitation of revenue enhancement initiatives involving multiple clinical departments and practices focusing on revenue cycle integrity. The Senior Clinical Nurse Auditor applies a variety of continuous improvement and process improvement initiatives collaborating with individuals and teams from project conception to implementation of process improvement initiatives. Project work may include technical analyses or may require facilitation of a large multi-disciplinary group of administrators and/or medical personnel.

 

Qualifications

Education
Bachelor's Degree in Nursing required or Bachelor's Degree Related Field of Study required

Licenses and Credentials
Registered Nurse [RN - State License] - Generic - HR Only preferred Certified Inpatient Coder [CIC] - American Academy of Professional Coders (AAPC) preferred Certified Professional Coder [CPC] - American Academy of Professional Coders (AAPC) preferred Certified Professional Coder-Hospital [CPC-H] - American Academy of Professional Coders (AAPC) preferred Certified Coding Specialist [CCS] - American Health Information Management Association (AHIMA) preferred Registered Health Information Technician [RHIT] - American Health Information Management Association (AHIMA) preferred

Experience
Auditing experience in the healthcare industry 3-5 years preferred or Auditing experience 3-5 years required

Principal Duties & Responsibilities

• Develop and perform clinical audits to support MGB’s overall revenue integrity. Clinical audits ensure that the clinical documentation contained within a patient’s medical record supports the items and services that appear on a patient’s bill; similarly, clinical audits ensure that all items and services provided to a patient are included on a patient’s bill.
• Research best practices, including implementation of new products or systems, for Revenue Integrity initiatives, and appropriately incorporates identified best practices into process design.
• Works with enterprise and/or clinical leadership to formulate strategies to lead improvement initiatives using various work processes, tools, procedures, and methodologies, including tracer audit approach, data analytics, process improvement methods, and other problem-solving approaches. Leads projects of increasing complexity (including complex systems, political, change, and organizational issues); able to work independently on business unit initiatives.
• Develop and document a clear and concise audit exceptions report when clinical documentation does not support charges included on a patient’s bill or when a compliance risk is identified. Collaborate with the Compliance team to implement corrective action plans.
• Develop corrective action plans as necessary to support appropriate revenue capture, including implementing process improvement, developing standard work, and creating clinical education to enhance revenue capture and documentation.
• Utilize charge capture audit software to identify opportunities to improve charge capture and collaborate with clinical and revenue cycle teams to implement corrective action plans to secure revenue capture on the front-end (rather than through perpetual audit activity).
• Develop and implement best practice charge capture processes to support the organization’s financial performance and ensure compliance with federal and state regulatory requirements.
• Works collaboratively with leadership to increase efficiencies, reduce variability, reduce errors/defects, and invol