Tenet Healthcare Sr Clinical Auditor in Detroit, Michigan
Under limited direction, review and approve clinical research studies submitted for DMC review by various investigators and research groups.
Reviews and verifies all DMC assigned research studies are conducted utilizing “Good Clinical Practices” and ensures all policies and procedures are adhered to according to DMC CRO. Conducts complex review(s) of research studies, audits studies, and ensures the accuracy and completeness of all regulatory documents for all DMC studies submitted via the DMC Clinical & Transition Research Office (research review website). Provides both clinical and technical expertise and acts as a liaison and resource to other DMC departments.
Ensures the accuracy and completeness of all regulatory documents for all DMC research studies submitted for review. Monitor clinical studies for follow-up, reporting, and/other research related activities as assigned. Ensures appropriate documentation for all assigned research studies.
Conduct audits when requested, ensures documented charges are correctly billed and billed charges are documented appropriately. Identifies, reports, and recommends actions to improve research processes when appropriate. Safeguards the assets of the DMC, advocates appropriate levels on internal controls and promotes operating effectiveness and efficiency. Prepares reports for audits when requested.
Must be a team player and able to work independently. Ability to communicate with all DMC affiliates. Ability to solve complex problems. Ability to follow DMC/Tenet policies and procedures and follow appropriate chain of command.
Ensures documented charges are correctly billed and billed charges are documented in the medical record. Corrects billing errors in the Patient Accounting system and in some cases, the Cerner system. Identifies, repors and recommends actions to improve charge capture processes. Identifies new services and technology in the clinical setting and facilitates establishment of new charges. Conducts in-service training for hospital personnel to ensure understanding of the importance of effective charge capture and documentation of services performed. Conducts complex reviews of departmental processes which include registration, clinical activities, documentation and charge capture. Identifies opportunities to maximize billing in accordance with federal and state regulations. Safeguards the assets of the DMC, advocates appropriate levels of internal control and promotes operating effectiveness and efficiency. Defend the hospitals revenue through research, documentation and negotiation by participating in and acting as a content expert for the hospital in audits conducted by third parties including, but not limited to, Blue Cross Catastrophic audits; HOPP audits; MPRO audits and all commercial insurance audits. Provides both clinical and technical/billing expertise and acts as liaison and resource for user departments. Analyzes results, identifies trends and patterns and prepares monthly statistical and narrative reports for various levels of hospital and corporate management.
1.Bachelors Degree in Nursing. 2. Licensed Registered Nurse in the State of Michigan. 3.Three years of patient care experience in a hospital as a Registered Nurse, at least one of which should be in a critical patient care specialty area such as I.C.U., E.R. or O.R. 4. Charge audit or similar experience preferred. 5.One year experience as a Clinical Auditor.
Organization: Detroit Medical Center Shared Services
Title: Sr Clinical Auditor
Requisition ID: 1805020094