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Clinical Registered Nurse
Bethesda Health • Creve Coeur, MO 63141 • Posted 3 days ago
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In-person • Full-time • Mid Level
Job Highlights
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The Clinical Registered Nurse at Bethesda Health is responsible for conducting audits of medical billing documentation supporting claims billed to third parties, particularly Medicare and Medicaid. This role involves ensuring that services provided to residents and billed are consistent with medical record documentation and comply with billing regulations and standards. The nurse will also assist in educating clinicians and billing staff on compliance, prepare written reports of audit results, and respond to billing, coding, and documentation questions. Additionally, the role includes assisting with clinical reviews and quality measure education.
Responsibilities
- Conduct audits of medical billing documentation supporting claims billed to third parties.
- Ensure services provided to residents and billed are consistent with medical record documentation.
- Comply with billing regulations and standards.
- Assist in education of clinicians and billing staff on compliance.
- Provide education to clinical staff on the proper use of EMR reports related to documentation in the MDS.
- Prepare written reports of audit results and present them to management and billing staff with recommended corrective actions.
- Respond to questions from nursing/billing staff regarding billing, coding, and documentation.
- Work on joint projects with other internal compliance staff to resolve billing and documentation issues.
- Assist with periodic clinical reviews of long-term care communities in preparation for inspections.
- Assist with periodic review of Quality Measures and education of the interdisciplinary team.
- Monitor documentation patterns for accuracy of information through the use of reporting mechanisms within the electronic medical record software.
Qualifications
Required
- Registered nurse
- Bachelor degree preferred
- Active RN license in Missouri and Illinois, or willing to obtain as soon as possible
- Two years of Long-Term care experience, with at least one year as MDS Coordinator
- Knowledge of Medicare and Medicaid
- Experience training/teaching adults preferred
- Software skills in Word, Excel, Power Point or equivalent required
- Basic knowledge of and experience utilizing a personal computer
- Verbal and written communication skills
- Excellent interpersonal and organizational skills
- Manual dexterity, coordination and skillful use of hands for working with required equipment
- Ability to receive and express detailed information through oral communication
- Ability to read and understand written directions
Preferred
- Acute care experience
Full Job Description
Bethesda Brings out the Best in Talented, Caring People!
At Bethesda, more than 1,200 employees dedicate their careers to improving the lives of others.
As a team member at Bethesda, you'll enjoy great benefits such as: 403b, daily pay, bonuses, career advancement opportunities, and holiday pay.
Medical, dental, vision, prescription, and life insurance available for regular status full and part time employees.
Summary
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.
Job Qualifications
Category: RN
At Bethesda, more than 1,200 employees dedicate their careers to improving the lives of others.
As a team member at Bethesda, you'll enjoy great benefits such as: 403b, daily pay, bonuses, career advancement opportunities, and holiday pay.
Medical, dental, vision, prescription, and life insurance available for regular status full and part time employees.
Summary
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.
Job Qualifications
- Registered nurse, bachelor degree preferred
- Active RN license in Missouri and Illinois, or willing to obtain as soon as possible
- Two years of Long-Term care experience, with at least one year as MDS Coordinator
- Acute care highly desirable
- Knowledge of Medicare and Medicaid required
- Experience training/teaching adults preferred
- Software skills in Word, Excel, Power Point or equivalent required
- Basic knowledge of and experience utilizing a personal computer
- Verbal and written communication skills
- Excellent interpersonal and organizational skills
- Manual dexterity, coordination and skillful use of hands for working with required equipment
- Ability to receive and express detailed information through oral communication, visual acuity
- Ability to read and understand written directions
Category: RN
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