Job Description

Job Description

About Us

Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well.

Our Core Values are:

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• We serve faithfully by doing what's right with a joyful heart.
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• We never settle by constantly striving for better.
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• We are in it together by supporting one another and those we serve.
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• We make an impact by taking initiative and delivering exceptional experience.
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Benefits

Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:

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• Eligibility on day 1 for all benefits
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• Dollar-for-dollar 401(k) match, up to 5%
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• Debt-free tuition assistance, offering access to many no-cost and low-cost degrees, certificates and more
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• Immediate access to time off benefits
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At Baylor Scott & White Health, your well-being is our top priority.

Note: Benefits may vary based on position type and/or level

Job Summary

In this job, as a Clinical Auditor RN, you'll perform charge capture accuracy audits by reviewing and analyzing clinical documentation from the Electronic Health Record (EHR) compared to patient charges and bills. These audits are intended to review for overcharges, undercharges, or inappropriate charges through numerous audit programs.  The audits consist of both hospital/technical charges as well as professional/provider charges.

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• Hybrid position 
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• Must live in BSWH Service area (Dallas preferred) - will be onsite for training and as needed for specific projects/events.
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Essential Functions of the Role:

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• Manage planning, organizing, and executing audit tasks in clinical departments/functions.

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• Evaluate clinical documentation for compliance, meeting all regulations stipulated by federal and state agencies as well as third-party payers.

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• Look for opportunities to enhance performance and provide counsel to Revenue Integrity team members and/or clinical departments/functions.

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• Documents and tracks audit findings for account corrections and issue identification and mitigation.

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• Summarizes audit results in a clear and concise manner.

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• Propose actions aimed at improving internal controls and boosting operational efficiency and effectiveness.

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Key Success Factors

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• Nursing experience in an acute care hospital and/or outpatient clinic setting with general knowledge of all nursing/medicine specialties in addition to hospital and outpatient clinic workflows.

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• Ability to accurately examine, interpret, and understand clinical documents or medical records to understand what occurred during patient encounters.

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• Ability to evaluate clinical documentation compared with medical charging and billing to determine if accounts have been charged appropriately, and subsequently, make recommendations for charge corrections.

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• Comfortable working alone and in a team. Self-motivated, problem-solver in a fast-paced setting, eager to learn and grow.

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• Being able to handle complex tasks through a structured, detail-oriented, and organized manner.

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• Comfortable providing training and education related to clinical issues as necessary.

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• Having excellent communication skills to initiate executive-level correspondences that are clear, concise, and free of grammatical inaccuracies.

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• Strong working knowledge of Microsoft Office Suite, particularly Excel, Word, PowerPoint, and Outlook.

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• Bachelor's degree preferred
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• 5-10+ years of experience, in multiple hospital and/or outpatient settings, strongly preferred

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• Must live within Baylor Scott & White service area (ideally in DFW Metroplex)

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Belonging Statement

We believe that all people should feel welcomed, valued and supported, and that our workforce should be reflective of the communities we serve.

Qualifications

• Bachelor's degree or having four years of work experience.
• At least (2) two years of relevant work experience.
• Registered Nurse License.

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