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Memorial Hermann Health System

Clinical Auditor

Houston, Texas

Overview

Welcome to Memorial Hermann where each of our more than 27,000 employees and 6,700 affiliated physicians share a commitment to helping one another, our patients and our communities. Here, you’ll work alongside the best professionals in the business with the goal of providing the best care possible. We offer an employment experience like no other, and we’ve proudly served this community for more than 110 years. At Memorial Hermann, the health of our community is always at the center of what we do.

  • Job Type: Full-Time, Part-Time
  • Job Level: Senior
  • Travel: Varies by role
  • Glassdoor Reviews and Company Rating Glassdoor Reviews and Company Rating

SUCCESS PROFILE

What makes someone successful at Memorial Hermann?
Check out the top traits we're looking for and see if you have the right mix.

  • Analytical
  • Collaborative
  • Detail Oriented
  • Personable
  • Insightful
  • Helpful

Quote

It is so exciting to work for a company that truly sticks to their vision and values in terms of how we deliver patient care every day. We are constantly looking at ways to improve the lives of those in our communities, and that is what excites me the most.

– Julie B., PBS Manager

TOTAL REWARDS

  • Health Insurance

  • Retirement Plan

  • Paid time off

  • Certification reimbursement

  • Tuition reimbursement

  • Student Loan Repayment

JOB DESCRIPTION

Title Clinical Auditor Location 909 Frostwood, Houston, TX 77024 Category Financial Services Type Full time Requisition 100117255 Date posted 11/30/2021

At Memorial Hermann, we’re about creating exceptional experiences for both our patients and our employees. Our goal is to provide opportunities for our diverse employee population that develop and grow careers in a team-oriented environment focused on patient care.

Every employee, at every level, begins their journey at Memorial Hermann learning about the history of the organization and its established culture built on trust and integrity. Our employees drive this culture, and we want you to be a part of it.

Job Summary

Position is responsible for coordinating and implementing multiple billing and quality audits as assigned.

Job Description

Minimum Qualifications

Education:  Completion of Nursing Program; Bachelors of Nursing preferred

License/ Certification: Current and valid license to practice as a Registered Nurse (ADN or BSN) or LVN in the state of Texas.

Experience / Knowledge / Skills:

  • Minimum two (2) years of experience in finance, operations, audit or consulting with a hospital or managed care focus
  • Minimum two(2) years of clinical experience, preferably critical care
  • Knowledge of the American Association of Medical Audit Specialists standards and TJC Core Measures as appropriate
  • Self-motivated, proven communication skills, assertive, critical thinking skills
  • Working knowledge of Word and Excel
  • Effective oral and written communication skills
  • Demonstrates commitment to the Partners-in-Caring process by integrating our culture in all internal and external customer interactions; delivers on our brand promise of “we advance health” through innovation, accountability, empowerment, collaboration, compassion and results while ensuring one Memorial Hermann.

Principal Accountabilities

  • Performs billing and quality audits based on medical audit standards as promoted by the American Association of Medical Audit Specialists standards.
  • Performs quality audits using TJC Core Measures standards.
  • Establishes and maintains good professional rapport with insurance companies, physicians and staff while obtaining necessary data.
  • Prepares reports of audits identifying trends or gaps in practice to be given as feedback to Departments.
  • Assures proper confidentiality and complies with HIPAA guidelines.
  • Coordinates findings of billing audits with insurance companies as appropriate.
  • Ensures safe care to patients, staffs and visitors; adheres to all Memorial Hermann policies, procedures, and standards, within budgetary specifications, including time management, supply management, productivity, and accuracy of practice.
  • Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.
  • Other duties as assigned.
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