Clinical Quality and Charge Auditor - 9447

Clinical Quality And Charge Auditor

Location: Skagit Valley Hospital

Department: Operating Room

Schedule: DAYS - VARIABLE

Position Type: Full Time 0.6 FTE or More

FTE: 1.000000

Base Wage: $ 44.64 to $ 66.96

Job Summary

Ensures clinical quality in Surgical Services meets regulatory guidelines, medical, nursing and infection prevention clinical guidelines and SRH policy requirements. Ensures all appropriate billing charges are captured, documented, charged and reimbursed. Works effectively and cooperatively within the workplace. Location/Department specific tasks and competencies may apply.

Essential Functions

The Clinical Quality and Charge Auditor Surgical Services will be responsible for the review of patient charts for all SRH Surgical Services locations to ensure provider and staff coding and documentation is correct and appropriate. This position ensures documentation practices are consistent with established standards, procedures, and requirements. Optimizes quality of care for patients by reviewing clinical quality, ensuring regulatory compliance, and in-depth analysis of clinical practice. Commands a comprehensive knowledge of clinical criteria, regulatory requirements, medical, nursing, infection prevention and other clinical societal guidelines, SRH policy and other processes which are required to support the review of the clinical documentation/information. Pro-actively and consistently applies the regulatory and accreditation standards to assure that activities are reviewed and processed within guidelines. Maintains knowledge of clinical guidelines as established by clinical and regulatory organizations including but not limited to AORN, ASPAN, ACS, ASA, ASGE, SGNA, AAMI, APIC, CDC, DOH and DNV. Takes an active role in implementation of effective practices designed to reduce error, create reliability systems, mitigate risk and improve patient outcomes. Recommends change, policies or programs that could prevent future errors in SRH Surgical Services. Supports patient safety improvements by demonstrating expert knowledge and ability to execute change as well as train staff in best practices. Works with OR leaders to coordinate and investigate quality of care concerns using analysis tools. Designs actionable data reports and displays for various internal and external audiences that effectively direct further improvement efforts and drive action. Supports SRH Surgical Services quality dashboard and quality reporting. Attends and provides quality reporting for designated Surgical Services committees and other SRH committees as requested. This position also requires creating and processing reports out of the electronic health record EHR and disseminates meaningful, useful reports and provides recommendations to OR leadership. Prepares communications for quality standards, patient safety activities and improvements made to share across SRH Surgical Services locations. Responsible to review assigned surgical logs for all SRH Surgical Services locations, and assess the medical record documentation, plus system-generated and manually-entered charges, determine discrepancies, work with individual physicians and/or clinicians on clarification, and post-surgical charges for all SRH surgical patients accounts. Responsible for supporting maintenance of surgical billing WQs. Educates staff on proper documentation techniques and charging guidelines, and recommends amendments to the chargemaster, where appropriate. Communicates routinely with departments including Patient Financial Services and Coding to ensure billing integrity through proper charging of patient accounts. Ensures coordination with Information Systems, Managed Care, Chargemaster and Revenue Integrity for optimal system performance. Understands supplemental codes, CPT & HCPC Coding rules and regulations. Surgical Service Clinical Quality and Charge Auditor supports charge dashboards and charge reporting for SRH surgical locations. Maintain ability to effectively utilize Microsoft Office (Outlook) and department specific software applications to perform work. Communicate effectively and cooperatively in the workplace. Actively contribute to the achievement of Quality Improvement and Lean Process Improvement activities. Complete all mandatory learning requirements in a timely manner. Attend and actively participate in all department, team and/or committee meetings. Complies with all Skagit Regional Health policies and procedures. Performs other duties as assigned.

Education

Bachelor's degree in nursing or another clinical discipline required or within 3 years of hire. Masters in Health Administration, business or health-care related field preferred.

Experience/Training

Minimum three (3) years related work experience in a healthcare environment. Exposure to healthcare charge posting, billing, revenue cycle as well as Quality experience highly preferred. Surgical Services quality metric reporting preferred. Prior experience in quality assessment and improvement work preferred. An equivalent combination of education and experience may be substituted for requirement.

License/Certifications

Current and unrestricted Washington State Department of Health RN license required. ISO, CPHQ, Six Sigma and Lean certifications preferred.

Other Skills

Effective verbal, written and interpersonal communication skills required. Expert level computer skills and utilize Microsoft Office applications to perform work. Expertise in Excel, PowerPoint and Word Applications required. Well-developed problem solving and analytical skills required with a high degree of accuracy. Possess critical thinking skills and utilize independent judgement. Must thrive in a fast-paced environment and be able to work autonomously to drive assignments and meet multiple demands simultaneously. Experience with data analytics utilizing and running reports in Electronic Health Record software preferred. Experience with Epic and Epic reporting systems a plus. Possess knowledge of surgical services care delivery practices and understanding of data available across the care continuum as well as possess strong skills in collection, analysis and management of clinical and operational data. Must be able to effectively prioritize workload amongst frequent interruptions with competing priorities. Knowledge of current coding rules and guidelines a plus.

Physical Demands and Work Environment

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for long periods of time; when working in office. Repetitive tasks such as typing, sitting, answering phones, and interacting with computers and computer systems most of the day is a function of the position. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to focus. This position requires working in an indoor, environmentally controlled environment when in the office.

Skagit Regional Health offers a comprehensive benefit package including medical, dental, vision, 457b/401a (retirement), long term disability, and paid time off to all employees holding an FTE of 20 or more hours per week. Eligible employees also receive sick time pay.