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Job Summary: The Compliance Nurse Auditor assists with and supports the compliance program activities within Saint Francis Health System (SFHS). This role supports clinical coding and billing audit functions as well as the performance of routine and complex audits, oversight activities, and coordinates remediation and corrective action plans.

Minimum Education: Has completed the basic professional curricula of a school of nursing as approved and verified by a state board of nursing, and holds or is entitled to hold a diploma or degree therefrom.

Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License.

Work Experience: Minimum 3 years of healthcare compliance clinical auditing experience within a hospital setting.

Knowledge, Skills and Abilities: Strong knowledge of Centers for Medicare and Medicaid Services (CMS) guidance, regulations, policies, and direction from other government programs. Advanced proficiency within Microsoft 365. Ability to learn departmental and job-specific software programs. Excellent communication skills, both written and verbal that present clear and concise information. Superior ability to collect, analyze, and disseminate significant amounts of data with attention to detail and accuracy. Strong project management skills with the ability to manage multiple priorities simultaneously.

Essential Functions and Responsibilities: Provides compliance program support with audits and monitoring, corrective action plan management, data analytics, and other projects to ensure proper execution of the compliance program work plan and priorities. Performs audits to ensure that the clinical documentation contained within the patient chart supports items and services included on claims and accurately supports reasons for treatment, billing, payment, and operations. Performs clinical review audits to validate compliance with regulatory requirements such as Emergency Medical Treatment Labor Act (EMTALA), Discharge Planning, and Quality. Provides independent evaluations and assists with the maintenance of operational controls, tools, policies, and procedures. Conducts regulatory research to identify gaps and provides interpretation of clinical requirements and regulations to ensure appropriate application of medical and clinical criteria. Remains abreast of current developments in compliance.

Decision Making: Independent judgment in planning sequence of operations and making minor decisions in a complex technical or professional field

Working Relationships: Works with internal and/or external customers via telephone or face to face interaction. Works with other healthcare professionals and staff. Works frequently with individuals at Director level or above.

Special Job Dimensions: None.

Supplemental Information: This document generally describes the essential functions of the job, and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.

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