Phelps Health is a 2000-employee-strong hospital and healthcare system serving the heart of small-town Missouri.No matter where you start with us, we're committed to taking our team to the top. If you're ready for the challenge of providing life-saving care or supporting those who do, read on to find your fit in the Phelps Health family.
General Summary- The Compliance Nurse Auditor provides support to the Corporate Compliance Office in areas of compliance audit and clinical expertise.
Essential Duties and Responsibilities- Audits conducted in accordance with the audit methodologies defined in the Ethics, Compliance and Privacy Plan.
- Ensures compliance with hospital policy and all applicable state and federal laws and regulations when performing audits.
- Works with various staff and departments such as Health Information Management, coding and billing department, the clinical nursing units, physicians, and others to obtain the information necessary to perform audits.
- Conducts organizational audits and reviews as directed to cover areas or functions of the hospital identified as potential compliance risks.
- Perform risk assessments in both clinical and business areas that have been identified by annual OIG Work Plan as potential areas of concern.
- Conducts medical necessity reviews in a timely manner, working with coding, billing, and CDI professionals to assure compliant billing of services documented in the medical record.
- Demonstrates knowledge on CMS and State regulations regarding acute hospital services, physician clinics, home health, hospice, and ambulance services.
- Recommends and implements quality control systems to ensure that assigned functions and activities are efficient, effective and in compliance with internal policies and with both state and federal regulations.
- Conducts special studies and projects as assigned; researches and analyzes information; prepares statistical and narrative reports and documents as needed.
- Assists with corrective and preventive actions and process improvements with hospital departments as a result of audit findings.
- Assist the Ethics, Director of Corporate Compliance in providing education for hospital staff in Compliance matters.
- Works autonomously and complete duties timely.
- Reports and communicates all findings to the Director of Corporate Compliance in a timely manner.
- Demonstrates proficiency in Epic and legacy systems navigation of Electronic Health Record (EHR).
Education- Graduate of an accredited school of nursing. Bachelor's or Master's in Nursing preferred. Certification in Compliance preferred.
Work Experience- At least 5 or more year's clinical nursing experience required. Experience in corporate compliance preferred.
Certification/License- RN License in Missouri or Compact State required.
Mental/Physical Requirements- Ability to concentrate, pay close attention to detail and perform duties under time restrictions. Ability to sit for long periods. Must be able to handle and transport 25 pounds.
Working Conditions- Standard office conditions
At Phelps Health, we think we have a better team, benefits, and opportunities for growth than anyone else around, and we invite you to see for yourself! Apply now to join us on our mission in health care.