Bethesda Health RN Specialist

Job Title: Medical Billing Documentation Auditor

Job Description:

• Conduct audits of medical billing documentation supporting claims billed to third parties, particularly Medicare and Medicaid.
• Ensure services provided to residents and billed are consistent with medical record documentation and in accordance with appropriate third-party billing regulations and/or standards.
• Communicate findings to appropriate personnel.
• Emphasize MDS auditing and best practices documentation.
• Conduct internal audits of medical documentation supporting claims billed to third parties.
• Assist in educating clinicians and billing staff to support compliance with third-party documentation and billing standards.
• Provide education to clinical staff on the proper use of EMR reports related to documentation in the MDS.
• Prepare written reports of audit results and present them to management and billing staff with recommended corrective actions.
• Respond to questions from nursing/billing staff regarding billing, coding, and documentation.
• Work on joint projects with other internal compliance staff to resolve billing and documentation issues.
• Follow established policies and procedures, quality assurance, safety, environmental, and infection control standards.
• Assist with periodic clinical reviews of long-term care communities in preparation for governmental or other accrediting body inspections.
• Assist with periodic review of Quality Measures and education of the interdisciplinary team.
• Monitor documentation patterns for accuracy through the use of reporting mechanisms within the electronic medical record software.

Requirements:

• Registered nurse, bachelor's degree preferred.
• Active RN license in Missouri and Illinois, or willing to obtain as soon as possible.
• Two years of Long-Term care experience, with at least one year as MDS Coordinator.
• Acute care experience is highly desirable.
• Knowledge of Medicare and Medicaid required.
• Experience training/teaching adults preferred.
• Software skills in Word, Excel, PowerPoint, or equivalent required.
• Basic knowledge of and experience utilizing a personal computer.
• Verbal and written communication skills.
• Excellent interpersonal and organizational skills.
• Manual dexterity, coordination, and skillful use of hands for working with required equipment.
• Ability to receive and express detailed information through oral communication, visual acuity.
• Ability to read and understand written directions.