Clinical Auditor - Part Time

HOSPICE AUSTIN • Austin, TX

6d

About The Position

Assist the Director of Quality and Compliance with compliance auditing and independent monitoring activities of Hospice Austin to ensure clinical and business areas (including but not limited to eligibility, billing, coding, clinical documentation and referrals) comply with applicable State and Federal laws and rules and regulations related to Medicare and Medicaid. This may include identifying areas of risk, performing audits, educating staff, and providing recommendations for quality improvement activities. All comments, actions and behaviors have a direct effect on the public’s perception of Hospice Austin. Interactions with patients, family members, physicians, referral sources, visitors, co-workers, etc. must be in a manner that is courteous, respectful, cooperative and professional. This behavior should promote an atmosphere of teamwork and positive relations. Office equipment.

Requirements

• Graduate of an accredited school of nursing.
• Unrestricted license as a Registered Nurse in the State of Texas.
• 2-3 years previous nursing (RN) experience.
• Hospice or home health experience.
• Previous experience using an electronic medical record (EMR) system.
• Proficient in Microsoft Excel.
• Data management experience for report writing and tracking.

Nice To Haves

• Microsoft Access knowledge preferred
• Suncoast (EMR) experience preferred

Responsibilities

• Audits clinical documentation for compliance, billing, and clinical quality issues.
• Determines and obtains 10% of ADC charts for quarterly record review audits.
• Reviews selected records to evaluate compliance with internal standards and regulatory and accreditation requirements related to specified audit topics, such as diagnosis documentation, visit frequency, plan updates, etc.
• Aggregates audit data reviewed and reports findings to Director of Quality and Compliance for dissemination to leadership and management, Quality Improvement Committee (QIC) & Performance Improvement Committee (PI Committee.
• Identifies compliance trends and makes recommendations for education needs and/or quality improvement initiatives.
• Supports documentation education with staff at the direction of the Director of Quality and Compliance for high risk/high frequency audit risks.
• Supports organizational compliance with laws, regulations, and accreditation standards.
• Records complaints related to patient care; communicates with managers and/or staff to provide feedback and/or resolve issues.
• Aggregates data and reports findings to Director of Quality & Compliance for dissemination to leadership, QIC and PI Committee as needed.
• Aggregates data on live discharges and communicates findings to the Quality Improvement (QIC) Committee.
• Identifies trends with compliance and/or quality deficiencies and makes recommendations for education needs and/or quality improvement initiatives.
• Audits live discharge records monthly in collaboration with the clinical teams (1st line audit) & Business Office to ensure accurate hospice claims.
• Assists in preparing all External Audits (ADR/CMS/HHSC/Part D) and ensuring they are sent out prior to the deadline.
• Logs all External Audits received and monitors to ensure that we receive the certified mail confirmation.
• Responsible for collection, verification, and transmission of accurate and timely Hospice Outcomes and Patient Evaluation (HOPE) data.
• Attends the Performance Improvement (PI) Committee.
• Other duties as assigned.

What This Job Offers

• Job Type: Part-time
• Education Level: No Education Listed