Surgical Services Auditor

MedStar Health; Washington (District of Columbia); On-site; USD 65,000 - 117,000; Full time

Job summary

MedStar Health is seeking a Surgical Service Auditor to review clinical documentation in Perioperative and Procedural departments for charging accuracy, regulatory compliance, and quality outcomes. The role partners with service line managers and supply chain to ensure proper pricing and documented charges across the OR and endoscopy suites.

The position supports the revenue cycle and requires an associate's degree or related surgical services training, with RN or CST licensure.

Qualifications

• Associate's degree required or
• One to three years formal training in a related surgical services field required
• RN - Registered Nurse licensure and/or Compact State Licensure required or CST - Certified Surgical Technologist required

Responsibilities

• Reviews charging for procedures, implants, recovery and related charges for accuracy.
• Reviews monthly spend and identifies opportunities to reduce expense.
• Assigns and reviews HCPC and charge codes for implants and supplies.
• Reviews OR records for unbilled supplies and initiates builds in the EMR.
• Collaborates with nurse managers clinicians supply chain and revenue control specialists to ensure correct pricing and charging.
• Provides OR information system training and system administration support as needed.

Job description

About the Job

Serves as the auditor for all of Perioperative Services including Main OR 3rd Floor OR and the Endoscopy Suite ensuring timely and accurate information. Supports regulatory compliance as well as the revenue cycle to ensure each case record is accurate and all supply items have been assigned the appropriate charge. Under the direction of the Business Director for Perioperative Services the Surgical Service Auditor will be responsible for reviewing clinical documentation within all Perioperative and Procedural departments to audit for charging accuracy regulatory compliance and quality outcomes. The Surgical Service Auditor will partner with service line managers clinic/procedural schedulers Supply Chain associates and the Perioperative Charge Entry Coordinator.

Primary Duties and Responsibilities

• Reviews clinical documentation to determine if charging for the procedure supplies implants recovery and any other associated charges are documented accurately.
• Reviews monthly spend while identifying opportunities to reduce expense.
• Participates in the process of assigning and reviewing HCPC and charge codes assigned to implants and supplies.
• Reviews OR records for use of supplies not appearing on the billing document. Initiates the build process for items that are not built into the EMR.
• Participates in feedback process with nurse managers and clinicians to ensure documentation is corrected in a timely manner.
• Ability to work in multiple software applications to collaborate with supply chain and billing compliance to audit and identify the correct pricing and charging of supplies and implants.
• Works with vendors to obtain pricing/product information to maintain an accurate item master. Assigns a charge description master (CDM) number to non-stock specialty items and implants.
• Reviews and initiates purchase orders for the payment of supplies and equipment. Keeps records of purchases and audits/tracks patient and interdepartmental charges.
• Oversees the implementation and accuracy of new Perioperative contracts to ensure accurate pricing is maintained in the EMR. Reviews vendor invoices for specialty items and implants for corresponding OR cases to ensure accuracy of patient charges for billing documents.
• Assesses appropriate clinical documentation.
• Participates as ad-hoc Value Analysis committee members. Supporting VAC leadership in product/equipment assessment.
• Oversees the `un-finalized' case reports in Perioperative services and works with clinical staff to complete all documentation both timely and accurately.
• Knowledgeable of Hospital policies and organizational identied quality initiatives; incorporates this knowledge into audits to help drive documentation compliance in partnership with unit leadership.
• Partners with service line clinic and procedural schedulers OR managers resource nurse or supply coordinator and revenue control specialists to develop a working relationship and effective work group for problem solving.
• Develops and maintain clinical knowledge of areas auditing to maintain a clear understanding of what should be found within documentation.
• Provides OR information system training for clinical and non-clinical staff.
• Provides OR system administration and hardware troubleshooting support as needed

Minimal Qualifications

Education

• Associate's degree required or
• One to three years formal training in a related surgical services field required

Experience

• 1-2 years of progressively more responsible experience as a Surgical Technologist or as an RN with surgical nursing experience required
• Familiarity with OR information systems supply chain management information systems procedures and supplies used in general surgery as well as surgical subspecialties required

Licenses and Certifications

• RN - Registered Nurse - State Licensure and/or Compact State Licensure required or
• CST - Certified Surgical Technologist required

This position has a hiring range of

USD $65,062.00 - USD $117,291.00 /Yr.