ABOUT THE POSITION
The Nurse Auditor is an experienced healthcare professional with relevant experience in the field of risk management and quality improvement. This position plays a key role in the proper identification quality-based and risk-based adjustments/conditions within the clinical documentation. This position assists with the morbidity and mortality functions within CHC/SEK’s Compliance Department.
- Reviews and interprets patient records and care plans against criteria to determine appropriate documentation based on clinical practice guidelines and appropriateness of care; determines if the patient file documentation supports the patients’ need for services.
- Identifies documentation issues (e.g. lacking documentation) that impact risk management, quality improvement, and revenue cycle.
- Identifies opportunities to implement best practice approaches and innovations to improve outcomes and enhance organizational efficiency.
- Clearly communicates (verbally and in written reports or summaries) opportunities for documentation improvement related to risk adjustment coding and clinical documentation issues.
- Orients and educates staff to documentation standards, legal requirements, and the performance improvement process as necessary; reports aberrant and non-compliant occurrences.
- Assists with internal audits and surveys to ensure adherence to CHC/SEK policies, state and federal guidelines, and appropriateness of patient care.
- Completes assigned audit deliverables and surveys in a timely, efficient and accurate manner, meeting all identified deadlines.
- Able to translate EHR data into meaningful data outcomes.
- Assist with research, analysis, and review activities related to CHC/SEK’s Morbidity and Mortality functionalities.
- Reviews all CHC/SEK patient death certificates and does associated research, documentation, and follow-up, as directed by CHC/SEK’s Compliance Officer and/or Risk Manager.
- Supports other Risk Management and Quality Improvement efforts (e.g. peer review processes).
- Perform all duties, services and documentation in full compliance with CHC/SEK policies and procedures.
- Performs other duties as assigned.
- Registered Nurse with Three (3) or more years of experience required.
- Strong knowledge of quality improvement training (e.g. NCQA) preferred.
- Strong knowledge of risk management training and coding (e.g. HEDIS, ICD) preferred.