Clinical Analyst HPC Audits Job in Providence 02903, Rhode Island Us
Clinical Analyst HPC Audits
Lifespan Corporate Services is tobacco free and we do not hire users of tobacco products. If you are a user of tobacco products, you are expected to disclose this to Lifespan Corporate Services Human Resources.
Important Note: If you are applying for a position within Lifespan Corporate Services (LCS) and you are not currently employed in LCS, or in another Lifespan affiliate, you will not be considered for employment if you are a current user of tobacco products.
The Clinical Analyst Health Plan Contract Audits reports to the Manager Health Plan Contract Audits. Under general direction, assists in coordination and resolution of all non-government health plan audits for Lifespan and its affiliates. Performs preliminary scoping/investigative research of contract audit concerns, assesses issue and provides feedback regarding audit approach, including methods and time frames. Supports manager and Revenue Analyst Health Plan Contract Audits in data management. Interacts closely with manager to ensure thorough knowledge of on-going audits. As necessary, assists clinical compliance auditors and or clinical auditors.
Graduate of accredited program in professional nursing, with current licensure to practice as Registered Nurse in State of Rhode Island or in another state that participates in the Nurse Licensure Compact. Bachelor's degree in health science profession, preferably nursing.
Three to five years progressively more responsible experience in health care with strong emphasis in one or more of the following areas: clinical analysis, clinical reporting, healthcare operations, database management, coding and billing procedures, medical record auditing, documentation and departmental operations. Comprehensive understanding of microcomputer spreadsheet use and database management.
Knowledge of standard medical/nursing practice and diagnosis-specific treatment protocols.
General knowledge of third party reimbursement policies sufficient to compare details of diagnosis, prescription, treatment and evaluation to documentation necessary to obtain appropriate reimbursement for patient care services.
Knowledge of HCPCS and APC coding techniques, as well as contract language.
Strong analytical, organizational and communications skills are required.
Computer skills required in Microsoft Office products, including general database experience. Knowledge of personal computer software applications that interface with various billing databases preferred.
Project management familiarity.
