Compliance Nurse Specialist (RN) Job at Bethesda Health, Creve Coeur, MO

ZmN5b2Y2aDRldWRCOWNwSG5VR0xkRjRqS0E9PQ==
  • Bethesda Health
  • Creve Coeur, MO

Job Description

Compliance Nurse Specialist (RN) at Bethesda Health summary:

The Compliance Nurse Specialist (RN) at Bethesda is responsible for auditing medical billing documentation to ensure compliance with Medicare and Medicaid regulations. This role involves educating clinical and billing staff on documentation standards, preparing audit reports, and addressing billing inquiries. The position requires a registered nurse with experience in long-term care and knowledge of third-party billing practices.

Bethesda Brings out the Best in Talented, Caring People!

At Bethesda, more than 1,200 employees dedicate their careers to improving the lives of others.

As a team member at Bethesda, you'll enjoy great benefits such as: 403b, daily pay, bonuses, career advancement opportunities, and holiday pay.

Medical, dental, vision, prescription, and life insurance available for regular status full and part time employees.

This is a Part Time Hourly Position

Summary

Responsible for conducting audits of the medical billing documentation supporting claims billed to third parties, particularly Medicare and Medicaid. These audits determine whether services provided to residents and billed, are consistent with medical record documentation and in accordance with appropriate third-party billing regulations and/or standards. Findings are communicated to appropriate personnel. Emphasis will be placed on MDS auditing and best practices documentation. Conducts internal audits of medical documentation supporting claims billed to third parties and billing is done in accordance with appropriate third-party regulations/standards. Assists in education of clinicians and billing staff to support compliance with third party documentation and billing standards. Provides education to clinical staff in the proper use of EMR reports related to documentation in the MDS. Prepares written reports of the results of the audits and presents them to management and billing staff with recommended corrective actions. Responds to questions from nursing / billing staff regarding billing, coding and documentation. Works on joint projects with other internal compliance staff to resolve billing and documentation issues. Follows established policies and procedures, quality assurance, safety, environmental and infection control standards. Assists with periodic clinical reviews of long-term care communities in preparation for governmental or other accrediting body inspections. Assists with periodic review of Quality Measures and education of the interdisciplinary team. Monitors documentation patterns for accuracy of information through the use of reporting mechanisms within the electronic medical record software.

Job Qualifications

  • Registered nurse, bachelor 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 highly desirable
  • Knowledge of Medicare and Medicaid required
  • Experience training/teaching adults preferred
  • Software skills in Word, Excel, Power Point 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

Category: RN

Keywords:

compliance nurse, medical billing audits, Medicare, Medicaid, long-term care, MDS Coordinator, electronic medical record, documentation standards, clinical education, healthcare compliance

Job Tags

Hourly pay, Daily paid, Holiday work, Full time, Part time,

Similar Jobs

Lifelancer

CRA II/ Sr CRA- Central Region Job at Lifelancer

 ...Job Description Job Description Job Title: CRA II/ Sr CRA- Central Region Job Location: Urbana, IL, USA Job Location Type: Remote Job Contract Type: Full-time Job Seniority Level: Mid-Senior level Description Syneos Health is a leading fully... 

Headway

LMHC (Remote) Job at Headway

Remote Licensed Mental Health Counselor (LMHC) Wage: Between $90-$127 an hour Are you a Licensed Mental Health Counselor looking to launch a private practice, or grow your existing practice? Headway can help you earn more through insurance! Headway supports thousands...

Tulsa Public Schools

Library Assistant Job at Tulsa Public Schools

 ...Full Job Description: Library Assistant Grade: Hourly 4 Highly Qualified by Test Hourly 6 Highly Qualified by Education Tulsa Public Schools' existing salary schedules provide career increment adjustments based on education/experience and/or years of creditable... 

Aetherflux

Electrical Engineer Job at Aetherflux

 ...About Aetherflux Aetherflux is pioneering space-based solar power technology, focusing on designing satellites equipped with high-power laser systems to beam energy from space to Earth. We are building a dynamic team of engineers passionate about working at the forefront... 

Takeda Pharmaceutical

Global Oncology Regulatory Manager (Hiring Immediately) Job at Takeda Pharmaceutical

By clicking the Apply button, I understand that my employment application process with Takeda will commence and that the information I provide in my application will be processed in line with Takedas Privacy Notice and Terms of Use . I further attest that...