Job Ref: 10677
Talent Area: RN - Performance Improvement/Quality
Houston, TX 77005
Area/Department: Corp Rev Cycle-Transact Contro
Employment Type: Regular
Job Type: Full-Time
Organization: Houston Methodist
Work Shift: DAY
Work Week: M - F
Houston Methodist (HM) is one of the nation’s leading health systems and academic medical centers. HM consists of five hospitals: Houston Methodist Hospital, its flagship academic hospital in the heart of the Texas Medical Center and four community hospitals throughout the greater Houston metropolitan area. HM also includes a research institute, an international business division, numerous physician practices and several free standing emergency rooms and outpatient facilities. Overall, HM employs over 15,000 employees. FORTUNE magazine has placed Houston Methodist on its annual list of “100 Best Companies To Work For” since 2006. Houston Methodist is supported by a wide variety of business functions that operate at the system level to help enable clinical departments to provide the best patient care and service in a spiritual environment.
The Nurse Auditor will have full responsibility to audit patient charts (i.e., medical record) upon request from Payor’s on-site auditors, Patient Accounting, Risk Management, Revenue Cycle, and other network hospital entities needing completion of audit for reasons of treatment, payment or operations. The audit is conducted to ensure that the clinical documentation contained within the patient chart supports items and services that appear on the patient’s bill, and to ensure that all items and services provided are included on the patient bill. Where clinical documentation does not support items appearing on the bill, the Nurse Auditor will prepare a report of exceptions and offer solutions. The Nurse Auditor will ensure complete and timely responses to the requestor of the audit. Responses to audits may come in the form of verbal exit conferences and/or a written exchange of findings.
System and department specific ICARE values
INTEGRITY: We are honest and ethical in all we say and do.
COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
ACCOUNTABILITY: We hold ourselves accountable for all our actions.
RESPECT: We treat every individual as a person of worth, dignity, and value.
EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.
Duties and Responsibilities are cross-referenced to the hospital’s Pillars of Excellence and will be transferred to the Performance Evaluation.
This position description is not intended to be all inclusive, and the employee will also perform other reasonably related business duties as assigned by the immediate supervisor and other management as required. The Houston Methodist Hospital reserves the right to revise or change job duties and responsibilities as the need arises.
Bachelor of Science in Nursing or Associates Degree in Nursing
Prior nursing (hospital experience) and auditing experience, 5+ years preferred
CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED
Registered Nurse (RN)
SPECIAL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
Houston Methodist is an Equal Opportunity Employer.
Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, national origin, age, disability, status as a protected veteran or other characteristics protected by law.
VEVRAA Federal Contractor – priority referral Protected Veterans requested.