Company: Direct Staffing Inc
Posted on: February 16, 2020
Exp 5-7 years
This position can be located in Tacoma, WA; Seattle, WA;
Burlington, WA; Salt Lake City UT; Medford, OR; Portland, OR;
Candidates must work at least 6 months in the office before
telecommute work will be considered
--- Plan, coordinate, conduct and report on post payment claims
audits and performs related special projects as assigned.
Key Qualifications and Experience:
--- Proven knowledge of medical and surgical procedures and other
healthcare practices and trends.
--- General computer skills (including use of Microsoft Office,
specifically Excel and Outlook, internet search).
--- Familiarity with health care documentation systems.
--- Strong verbal, written and interpersonal communication and
customer service skills.
--- Ability to communicate audit outcomes and testing results with
other staff within the company who are both medically and
--- Ability to interpret policies and procedures and communicate
complex topics to others.
--- Strong organizational and time management skills with the
ability to manage workload independently.
--- Ability to think critically and make decisions within
individual role and responsibility.
--- Proven ability in developing and following an audit
--- Demonstrated competency in claim review and experience in using
billing and claims forms (UB, CMS, and HCFA).
Normally to be proficient in the competencies listed above:
--- Nurse Auditor would have a/an Associate or Bachelor's Degree in
Nursing or related field and 5 years of hospital quality
management, coding or medical auditing experience or equivalent
combination of education and experience.
Required Licenses, Certifications, Registration, Etc.
--- Registered nurse (RN) license (must have a current unrestricted
RN license for medical care management).
--- Certified Coder certified with the American Academy of
Professional Coders (AAPC) or the American Health Information
Management Association (AHIMA) preferred.
General Functions and Outcomes:
--- Applies clinical expertise and judgment to ensure payments
comply with medical policy, medical necessity guidelines, and
accepted standards of care.
--- Utilizes evidence-based criteria that incorporates current and
validated clinical research findings. Practices within the scope of
--- Understands and analyzes complex provider and hospital
contracts in order to ensure payments are for covered services.
--- Conducts coding audits, quality assurance assessments of
claims, reviews statistical samples and analyzes for risk.
--- Conducts surveys of complex audit areas to define the scope and
objectives of audits. Assists in the development of overall audit
plans, including comprehensive audit programs that identify
specific procedures and tests designed to achieve the audit
--- Identifies problems or needed changes, recommends resolution,
and participates in quality improvement efforts.
--- Responds in writing or by phone to members, providers and
regulatory organizations in a professional manner while protecting
confidentiality of sensitive documents and issues.
--- Provides consistent and accurate documentation.
--- Plans, organizes and prioritizes assignments to comply with
performance standards, corporate goals
Skills and Certifications
RN license in either WA, OR, ID, UT
Certified Professional Coder preferred
Ideal Candidate We have several positions open, with one being
specific for working with Skilled Nursing Facilities. We would
prefer candidates with specific experience in Skilled Nursing
Facilities or a varied skill set in a clinical setting, with chart
auditing experience strongly preferred.
Ideal Candidate should have worked for the following company(ies):
Any other health insurance plan
All your information will be kept confidential according to EEO
Direct Staffing Inc
Keywords: Direct Staffing Inc, Portland , Nurse Auditor, Accounting, Auditing , Portland, Oregon
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