Director, Medical Audits

The Director, Medical Audits is responsible for conducting process improvement assessments of revenue cycle operations in clinical areas with a focus on improving the accuracy and timeliness of charge capture. Assessments primarily consist of “chart-to-bill” audits, interviews with key stakeholders, direct observation of charge entry and reconciliation processes, and analysis of relevant charge data. Analyzes the assessment results and develops recommendations for process improvement.
 
This position will collaborate with the Finance Department and other clinical and operational areas to implement process improvement strategies. Measures and monitors compliance with regular review, interpretation and distribution of system reports. Designs new reports as needed to support charge capture metrics.
 
Performs follow-up and conducts education and training with lagging departments/clinical areas. Acts as the principal liaison between the Finance Department and clinical directors for charging. Functions as a resource to the Finance Department and clinical areas for charge capture, coding, documentation and reconciliation process subject matter. This job requires a high level of problem-solving. Must be able to work independently. Acts as a resource to the clinical departments. Computer skills are essential. Will need to use Word, Excel, PowerPoint and Visio at a minimum.
 
QUALIFICATIONS

• Education: Clinician (RN); bachelor’s degree.
• License/Certification: Registered nurse or other licensed healthcare practitioner required. Coding certification preferred.
• Experience: Five years of varied clinical experience as an RN or other clinical specialist. Bachelor’s degree in clinical program required. Master’s degree preferred. Working knowledge of coding rules required or willingness to obtain within 3 months of hire. Experience with billing and documentation systems preferred.

 
PERFORMANCE EXPECTATIONS

• Demonstrates the competencies as established by the department and on the Assessment and Evaluation Tool for this position.

 
WORK ENVIRONMENT

• Potential for exposure to the hazards and risk of the hospital environment, including exposure to infectious disease, hazardous substances and potential injury. This position requires desk/computer work a majority of the time. Requires some walking and standing and occasional lifting up to 20 lbs.

 
REPORTING RELATIONSHIP

• This position reports to the Director of Patient Accounting and supervises the PFS Medical Audit Coordinator.

 
The above statement reflects the general details considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all work requirements that may be inherent in the position.