Providence is calling a Nurse Auditor in Insurance Billing to Providence Health & Services in Spokane, WA.
The Nurse Auditor is responsible for providing a patient focused, standardized, compliant, sustainable revenue cycle that will support Providence in meeting financial objectives.
*Telecommute option available. Must reside in Alaska, California, Montana, Oregon or Washington.
In this position you will:
- Assess and provide recommendations on tools, training, education, organizational structure and process improvements related to clinical documentation and case management.
- Develop, monitor, and report key measurements and trends to ORC Compliance Leadership.
- Collaborate with facilities to identify minimum specifications and/or processes each needs in place to support compliant and accurate clinical documentation that supports medical necessity and other regulatory requirements.
- Collaborate with local facilities to identify and develop needed resources to provide education and evaluation of clinical documentation; serve as a resource for local ministries.
- Collaborate with clinical leadership to develop a proactive approach to meeting clinical documentation standards; interpret and communicate regulatory standards and their implications to clinicians and key internal constituents.
- Evaluate and audit medical records for accuracy and compliance to current work standards in support of regulatory appeals; communicate and document recurring problems, including business impact and possible resolutions.
- Reduce reporting variations by working with business office departments to identify issues impeding accurate, timely and relevant reporting.
Required qualifications for this position include:
- Bachelor's Degree in nursing and certification.
- Five (5) plus year's clinical experience in an acute care setting and three (3) plus years in a management or leadership role.
- Nursing Certification/Licensure required. (RN, BSN, MSN)
Preferred qualifications for this position include:
- Master's Degree in Health Care or Business Administration.
- Experience in a multi-hospital and/or integrated healthcare system.
- Three (3) plus years working in case management or similar function in an acute care setting.
- Case Management Certification.
About the department you will serve.
One Revenue Cycle (ORC) is the name adopted to reflect the Providence employees who work throughout Providence Health & Services in revenue cycle systems and structures in support of our ministries and operations in all regions from Alaska to California. ORC's objective is to ensure our core strategy, One Ministry Committed to Excellence, is delivered along with the enhanced overall patient care experience (know me, care for me, ease my way) by providing a robust foundation of services, operational and technical support, and the sharing of comprehensive, relevant, and highly specialized revenue cycle expertise
We offer a full comprehensive range of benefits - see our website for details
As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.
Providence Health & Services is the third largest not-for-profit health system in the United States. Providence employs more than 82,000 caregivers (employees) across a five-state area; AK, WA, MT, OR, and CA. Our facilities include 34 hospitals, 600 physician clinics, senior services, supportive housing and other health and educational services. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Nursing
Req ID: 150148