Description
Are you a Registered Nurse interested in building a rewarding career? This is a great position for talented candidates who are enthusiastic about using their skills to make a difference in the world of health care. Our fast-paced environment makes UPMC an exciting place to work for results oriented and driven self-starters. Join our team today!
Develops and maintains policy and procedure to monitor and assist compliance activities as it relates to clinical compliance, billing and audit processes. Performs audit activities to ensure agency compliance with regulatory and fiscal bodies.
Responsibilities:
- Provide on-going education related to audit results, compliance issues and HIPAA.
- Actively participatie in HHABN and NOMNC reviews.
- Assist with oversight of all external medical record requests.
- Initiate and facilitate the process of reconsideration for potential reversal of denial payment determinations.
- Identify, develop and participate in process improvement opportunities within the home health agency that will enhance the quality of the services we provide.
- Ensure completion of clinical compliance audit processes from internal and external sources.
- Focus on customer service and continually strive to perform the duties of job in a manner that results in optimal patient satisfaction.
- Represent at ALJ hearings as necessary.
- Support utilization functions with review and recommendations and provide on-going ADR education.
- Attend compliance training and adhere to the organization standards of conduct, policies and procedures.
- Develop, implement, perform and monitor audit activities to maintain agency compliance with fiscal and regulatory bodies.
- Provide coordination, final review and submission to the appropriate sources.
- Participate as ad hoc member on committees.
- Perform duties and job responsibilities in a fashion which coincides with the service management philosophy of UPMC towards patients, visitors, staff, peers, physicians and other departments within the organization.
Qualifications
- Graduate of an accredited school of professional nursing required.
- BSN, MSN preferred.
- Two (2) years experience in home health required.
- Demonstrated knowledge and proficiency in handling Medicare, Medicaid and commercial insurance regulations in order to maximize reimbursement.
Licensure, Certifications, and Clearances:
UPMC is an Equal Opportunity Employer/Disability/Veteran
Total Rewards
More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life &emdash; because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.
Our Values
At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.
