Clinical Auditor I – Revenue Integrity - Owensboro Health

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Clinical Auditor I – Revenue Integrity

Schedule: Full-Time Shift: Days
Owensboro Health Business Center Hours: 8a - 4:30p

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  • Job Summary
    • Performs medical and revenue audits to ensure revenue integrity as related to adherence to federal and state regulations: policies of external payers, coding rules, and guidelines. Exercises independent decisions using analytical and problem-solving skills. Provides critical analytical and negotiation support with respect to third-party payer reimbursement contracts. Requires a strong understanding of the specialized concepts, practices, and procedures in the area of specialization. Requires some assistance in tasking and prioritizing but able to work independently.
  • Job Responsibilities
    • Responsible for conducting quality control audits to ensure data/documentation integrity, communicating findings and recommendations, explaining regulatory requirements, and overseeing the corrective actions for audits within the operational units.
    • Compiles information and/or prepares reports and analyses, setting forth results of data integrity findings with appropriate recommendations; performs subsequent audits to ensure complete and appropriate corrective action has occurred.
    • Follows up with appropriate staff members to ensure accurate and complete documentation in the medical record. Works collaboratively with the appropriate operational leaders to develop provider education strategies to promote complete and accurate clinical documentation and correct negative trends and is able to impart this knowledge to providers and other staff members.
    • Conducts third-party defense audits, concurrent audits, and complaint audit as required.
    • Assists with responding to patients' inquiries concerning the accuracy of billed charges and charge descriptions
    • Assists with resolving third-party payor inquiries and billing disputes.
  • Organizational Responsibilities
    • Adheres to all organizational policies and procedures. Executes all tasks and behaves in a manner consistent with a culture of compliance, safety, and a high-reliability organization; behavior supports the organization's core commitments of Integrity, Service, Respect, Teamwork, Excellence, and Innovation.
  • Education
    • Associate's degree in business, healthcare administration, nursing, or other related field is required. Bachelor's degree preferred. A combination of education, training, and experience may be considered in lieu of degree.
  • Licensure/Certification/Registration
    • Licensed as a Registered Nurse (RN) preferred.
  • Work Experience
    • A minimum of 1 years' relevant experience in auditing, clinical documentation, medical appeals, clinical nursing and/or coding required.
  • Skills and Attributes
    • Requires critical thinking skills and decisive judgment. Works under general supervision. Must be able to work in a stressful environment and take appropriate action.
  • FLSA Classification
    • Non-Exempt
  • Disclaimer
    • This description is intended to describe the general nature and level of work performed by employees assigned to this position. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees. Specific duties and responsibilities consistent with the general nature and level of work described may vary by department and additional related duties may be assigned as needed. Some duties listed may not apply to all areas.
  • Additional Position Related Details
    • Populations Served
      • Training is provided relevant to the population served, based on the scope of care of the service assignment.

    • Physical Requirements
      • Activity and Frequency:
        • Bending/Stooping - Never
        • Climbing - Never
        • Keyboard Data Entry - Frequently
        • Kneeling - Never
        • Lifting/Moving Patients - Never
        • Lifting/Carrying (Non-Patient) - 0-25 lbs - Never
        • Lifting/Carrying (Non-Patient) - 25-75 lbs - Never
        • Lifting/Carrying (Non-Patient) - over 75 lbs - Never
        • Pushing/Pulling - 0-25 lbs - Never
        • Pushing/Pulling - 25-75 lbs - Never
        • Pushing/Pulling - over 75 lbs - Never
        • Reaching - Never
        • Repetitive Foot/Leg Movements - Never
        • Repetitive Hand/Arm Movements - Frequently
        • Running - Never
        • Sitting - Frequently
        • Squatting - Never
        • Standing - Frequently
        • Walking - Frequently
        • Audible Speech - Frequently
        • Hearing Acuity - Frequently
        • Smelling Acuity - Never
        • Taste Discrimination - Never
        • Vision: Depth Perception - Frequently
        • Vision: Distinguish Color - Frequently
        • Vision: Seeing - Far - Frequently
        • Vision: Seeing - Near - Frequently
    • Exposures
      • Owensboro Health is committed to providing a safe working environment including training and access to the personal protective equipment necessary to this position. While performing duties of this position, occupational exposure to bloodborne pathogens is present for all employees.
Contact Us

Want to learn more about joining our team? I invite you to email us your questions. Owensboro Health is an Equal Opportunity Employer.

Daniel Blandford, Human Resources Supervisor (right)

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