Career Story: Registered Nurse And Clinical Auditor

Registered Nurse And Clinical Auditor

Job Title: Clinical Auditor, RN

Type of Company: I work for a Level I trauma center in Raleigh, NC.

Education: Diploma, Michael Reese Medical Center School of Nursing (Chicago)

Previous Experience: I worked in medical-surgical nursing, then became a staff development coordinator. Next, I went into pharmaceutical sales helping to launch Advil. I then became the head of utilization management for an insurance company. A move to a new state launched a career working in auditing at a physician billing company. I finally returned to the hospital setting to be an internal clinical auditor.

Job Tasks: One of my main responsibilities is reviewing Medicare rules and regulations as they apply to the hospital health care setting. I identify the area of the hospital affected by these regulations and help management implement any changes that are needed. I work with the information technology department and claims and billing department to help implement these changes, then do testing and auditing to make sure the changes have occurred. I work with the staff who manage the hospital chargemaster, the file that drops all of the charges for hospital services. I make sure the managers of the various hospital departments understand billing rules and provide education when necessary.

Another main responsibility requires me to monitor various department level reports, give feedback, and develop educational materials as needed. I also belong to several standing committees so that I can be at the forefront of new services being added to the hospital and assist in getting the charge part of the service up and running. A recent example of this process occurred when the hospital added a wound care center. I had to research the rules and regulations, figure out what services would be provided and help set up the charges, then monitor the claims for accuracy, payment, etc.

Best and Worst Parts of the Job: The best part of my job is working with so many areas of the hospital. Something new is always happening, and I learn about a new technology, service, drug, treatment or process every day.

The worst part of my job is dealing with the ever-changing government rules and regulations that make the delivery of healthcare so complicated and cumbersome.

Job Tips:
1.) Spend at least 2 years at the patient bedside learning clinical nursing before branching off to try a non-clinical position.

2.) Take advantage of all learning opportunities offered.

3.) Challenge yourself to try new things, step outside of your comfort zone and don't be afraid to say this isn't for me and move on to something else.

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