Job Summary
Under the direction of Compliance Officer, within Department of Compliance Audit and
Appeals, Nurse Auditor will be responsible for responding to external audits including writing appeals, working
with Medical Staff and other staff. Nurse Auditor will be responsible for facility's communication and
interactions with CMS, Recovery Audit Contractors (RAC) and other third party auditors. Nurse Auditor will
document information and comments into the facilities tracking system to ensure audit deadlines are met.
Nurse Auditor will work with other departments to gather information, conduct internal audits set forth in the
OIG Work Plan and identify "problem areas" within the facility where changes to organizational practices,
policies or procedures might be needed to enhance organizational efficiencies and effectiveness.
Nurse Auditor, together with other members of the department, will prepare and monitor Corrective Action
Plans, conduct education and training and monitor for progress toward improved performance and
compliance. Other duties include conducting audits to identify problems and assisting the CFO as needed
with Healthgrades, MACRA/MIPS, data collection, analysis and ultimately educating physicians for
improvement.
Qualifications:
1. Bachelor's degree in nursing from an accredited program required.
2. Master's Degree in nursing, business or other health care related field preferred.
3. Current Mississippi Registered Nurse License.
4. Relevant Experience in a hospital setting.
5. Strong knowledge of state and federal law and regulations.
6. Understanding of CMS coverage and payment methodologies.
7. Excellent oral and written communication skills.
8. Advanced computer proficiency.
9. Excellent organizational skills and attention to detail.
10. Coding experience preferred.
11. Previous audit experience preferred.
12. Knowledge of InterQual and Principles of Managed Care preferred.
