Clinical Auditor - Employment Opportunity Details
Position Title: Clinical Auditor
Department: Internal Audit
Status:
Full-time
Description: The Clinical Auditor is an advanced professional level position working in Internal Audit/ Corporate Compliance, to serve as a liaison between clinicians and finance, and with departments, Directors and Managers throughout the health system. Responsibilities include planning and conducting compliance and internal audits and reviews as per the annual compliance and audit work plans, drafting reports, presenting findings and following up on implementation of recommendations. Projects include research, writing, interviewing, benchmarking, data analysis and other use of tools and techniques to address the audit and compliance needs of the organization. Additional responsibilities include overseeing effectiveness of on-going quality monitors impacting compliance and assess internal controls for process improvement, and presenting reports to Executive Management, Administrators, Directors and Managers as needed. The Clinical Auditor conducts audits in accordance with the Standards for the Professional Practice of Internal Auditing of the Institute of Internal Auditors (IIA).
Requirements: Clinical knowledge/experience required. RN preferred. Clinical Case Utilization Management desirable. This person needs to have an understanding of how the clinical pieces intersect with financial, legal, HIM, coding and ect. Must know who the key players are and how to pull them together.
The individual must be a self starter and capable of planning and performing Compliance, Operational and Financial Audits of moderate difficulty and complexity with minimal supervision.
Must be capable of working independently on reviews of patient charts and corresponding charges for appropriateness.
Extensive knowledge of payer requirements and hospital and medical clinic functions and activities
Extensive knowledge of IS systems in the healthcare setting
Extensive knowledge of Stark and anti-kickback laws and regulations
Knowledge of and proficient in the use of personal computers and major PC software
Strong analytic, investigative and interpretive skills
Skills in preparation and presentation, with knowledge of appropriate formats
Skills in delivering presentations to large groups
Skills in assessing alternatives
Oral and written communication skills
Skills in time management and able to effectively handle pressure to meet timelines
Ability to lead and motivate othersAbility to identify and assess design and operating effectiveness of internal controls
Ability to work independently and in groups
Ability to access government and industry databases for comparative data analyses and benchmarking
Ability to apply a test of reasonableness to each analysis and to question results before the task/analysis is complete
Ability to conduct all interactions and meetings with internal and external staff in a highly professional manner. Ability to communicate technical information with Directors, Managers and Staff. Ability to identify legal or compliance issues. Ability to think creatively and take initiative. Ability to accept and follow through on delegated responsibilities.
Pay Range: Salaried
Hours: 40