Remote Nurse Audit & Compliance Specialist – CMI, PDPM, MDS Experience

Career at Callmax Solutions - Philippines; Metro Manila; Presencial; PHP 360.000 - 600.000; Jornada completa

Descripción de la vacante

Callmax Solutions - Philippines in Metro Manila is seeking a detail-oriented Nurse Auditor to audit medical records and ensure compliant billing practices. The role requires an active PH RN license and strong clinical auditing experience, including MDS/quality measures and familiarity with EHR systems.

The successful candidate will review physician documentation, identify discrepancies, and prepare actionable reports while coordinating with care teams to uphold regulatory standards and improve

Formación

• Active PH Registered Nurse license.
• Extensive clinical knowledge and experience for auditing medical records.
• Proficiency with medical billing software and EHR systems.
• Experience in MDS and quality measures in nursing homes.
• Knowledge of healthcare regulations and laws for compliance.
• Coding background is a plus.
• Excellent written and verbal communication for reporting findings and coordinating with departments.
• Strong analytical and critical thinking to interpret data and medical records.

Responsabilidades

• Compile lists of nursing home patients requiring doctor visits based on vital signs and indicators.
• CPT Code Auditing: analyze weekly provider notes for accurate billing practices.
• Hospitalization Report Management: audit and investigate patient hospitalizations and provide updates from clinical notes.
• Occasional Invoice Auditing: compare coded notes with billing records to identify discrepancies.
• Regular audits of nursing documentation to ensure compliance with policies and regulations.
• Evaluate compliance with healthcare guidelines such as Medicare/Medicaid and accreditation standards.
• Analyze audit findings and prepare reports highlighting improvements, trends, and gaps.

Conocimientos

PH RN license

Clinical auditing

EHR systems

MDS & quality measures

Healthcare regulations

Medical coding

Communication skills

Analytical thinking

Descripción del empleo

Qualifications:

• Active PH Registered Nurse license.
• Extensive clinical knowledge and experience, as a thorough understanding of medical procedures, practices, and terminology, is necessary for auditing medical records.
• Proficiency in using medical billing software and electronic health record (EHR) systems.
• Experience in MDS and quality measures in nursing homes required
• Knowledge of healthcare regulations and laws to ensure the healthcare provider’s compliance with local, state, and federal law is a plus.
• Coding background is a plus.
• Excellent written and verbal communication skills for reporting findings, providing feedback, and coordinating with other departments or healthcare professionals.
• Strong analytical and critical thinking skills to interpret complex data and medical records.

Job Roles:

• Compiling lists of nursing home patients requiring doctor visits: Review 24-hour reports to identify nursing home patients requiring doctor visits based on vital signs and other indicators.
• CPT Code Auditing: Analyze weekly provider notes for accurate billing practices and potential copy-pasting issues.
• Hospitalization Report Management: Audit and investigate patient hospitalizations, tracking causes and providing detailed updates based on recent clinical notes.
• Occasional Invoice Auditing: Conduct detailed comparisons of coded notes and billing records to identify discrepancies.5. Perform regular audits of nursing documentation, processes, and patient care activities to ensure compliance with organizational policies, regulatory requirements, and accreditation standards.
• Evaluate compliance with Medicare, Medicaid, Joint Commission, and other relevant healthcare guidelines.
• Analyze audit findings and prepare detailed reports highlighting areas of improvement, trends, and compliance gaps.