Compliance Nurse Specialist (RN) - Bethesda Health

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.

Category: RN