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Medical Audit Coordinator, RN Specialist
At Kaiser Permanente our nurses are leaders, clinicians, researchers, innovators, and scientists who are contributing toward being an industry-leading voice for advancing evidence-based care. Whether supporting the patient directly in our hospitals or clinics, providing care at home, serving our patients through innovative virtual technology, or managing care delivery teams, Kaiser Permanente nurses utilize scientific evidence and our integrated care model to optimize the total health of our members and the communities we serve. We invite nurses who are passionate about nursing excellence, high-quality compassionate care delivery, professionalism, integrity, teamwork and patient and family centeredness to join our teams so that we can continue to sustain and build upon our culture of excellence.
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Job Schedule: Full-time
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Scheduled Weekly Hours:
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Shift: Day
Success Profile
We’re looking for Nurse Leaders who possess the following traits.
- Collaborative
- Compassionate
- Flexible
- Leadership
- Socially Conscientious
- Trustworthy
Benefits
We offer several benefits to our nurses.
Our Culture
At Kaiser Permanente, we cultivate an environment of compassion, integrity, trust, and open communication that helps our teams do their best work. We believe that lifelong learning will expand our knowledge so we can better serve our patients. Our practice is rooted in research and evidence-based care. Our nurses reflect the rich diversity of our members and communities and provide culturally responsive and competent care that promotes understanding of our members needs and preferences. At Kaiser Permanente, nurses are highly skilled professionals who exemplify leadership, critical thinking, and collaborative problem solving and deliver the right care, at the right time, in the right setting.
Hear From Our People
Caitlin
Inpatient Lactation Consultant
As an RN/IBCLC in Maternal Child, I’m meeting families at a pivotal time — I’m there to help launch a new family into the world. Everything I do has the potential to impact a family’s health for generations to come.
Kimberly
Quality Coordinator RN
In Hawaii, your community is your family — or ‘ohana.’ I am able to provide extraordinary patient-centered care to my ohana.
David
Appointment and Advice RN
The location is fantastic. Kaiser Permanente is all over the country. You can pick almost any environment you want — from ocean to mountain to city. You’ll still be able to contribute to our mission of providing high quality health care at a local facility.
Shawn
BSN, RN
I chose Kaiser Permanente because their staff and providers really show that they care about you. Also, throughout my 12 years of working here I’m always learning something new, and I’ve had many opportunities for growth and development.
Kristen
Relief Charge Nurse
Working as a nurse at Kaiser Permanente has allowed me the perfect flexible schedule so that I can volunteer as Girl Scout Leader and room parent for both my children. My kids know that I am a hardworking mother who can provide, as well as a mom who can be present and be there for them – and that means everything to me.
Jazmin
RN, Advice Nurse
Working for Kaiser Permanente has allowed me to take control of my future and make my goals a possibility. I feel that Kaiser Permanente allows me to keep climbing and moving. Having that ability truly makes me feel empowered.
Medical Audit Coordinator, RN Specialist
Review claims for services obtained outside of Kaiser facilities for compliance with health plan service agreement with members; identifies health plan claims with potential quality of care issues, continuity of care problems, or access issues at medical facilities; and audits hospital billings on site at non-plan provider facilities and negotiates successful resolution of claim.
- Provides clinical expertise to other departments such as Workers Compensation, CSA/MSA outside case management in areas related to hospital and physician billing practices and cost containment activities.
- Works with legal department when indicated to resolve payment disputes.
- Serves as a consultant to CSA Continuing Care teams and case managers on issues on non-pricing, billing problems, procedures and benefit compliance issues. Identifies opportunities for cost containment. Works with regulatory compliance for review of benefit.
- Responsible for review ICD-9, CPT codes, medical records, UB-92 and HCFA forms and Kaiser Permanente internal systems (OTRS, Advice call logs). Determines if bills are payable or if additional informatio is needed, identification of potential fraud issues.
- Works with PRS staff as a resource for decision-making and medical terminology.
- Plans and organizes daily work to meet compliance timeframes. Provides feedback to manager to ensure work is within compliance.
- Consistently supports compliance and the Principles of Responsibility (Kaiser Permanentes Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization.
- Acting with ethics and integrity, reporting non compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licenser requirements (if applicable), and Kaiser Permanentes policies and procedures.
- Minimum five (5) years of clinical experience.
- Graduate of an accredited nursing program required.
- High School Diploma or General Education Development (GED) required.
- N/A
- Must have demonstrated ability to work independently and make quick decisions with a high degree of competency utilzing multiple sources of information.
- Compentency in Microsoft Suites (Excel, Access, PowerPoint), excellent ability with proprietary, mainframe processing systems and KP technologies.
- Demonstrates strong understanding of medical terminology, ICD-9 coding, CPT coding principles.
- Must be able to work in a Labor/Management Partnership environment.
- Minimum five (5) years of clinical experience in critical care preferred.
- The ability to make timely, sound decisions, and to act independently and negotiate successful resolution in difficult situations preferred.
- Certification or course completion certificates in coding preferred.
- Familiarity with ICD-9 and CPT coding, hospital billing practices preferred.
- Bachelors degree preferred, OR four (4) years of experience in a directly related field.
- Must have RN license in US and be able to obtain RN license in GA.
- Looking for someone with ICU and UM experience.
Notes:
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Industry Leader
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Ranked among the nation's best
Every hospital that's part of the Kaiser Permanente system earned “high performing” recognition in the latest U.S. News and World Report's annual rankings. That means all 39 of our hospitals are among the top 20% in the nation.
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Awarded for excellence
We're proud that so many of our hospitals have earned Magnet status. It shows our real commitment to outcomes, safety, quality, efficiency, and, most importantly, to our nurses.
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Recognizing nurses during Nurses Month in 2022
We're thanking each one of our 65,000 Kaiser Permanente nurses for everything they've done for us and for the nation. Thank you for choosing to be a nurse and for leading our transformation of care.
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Explore a career in nursing
When you join Kaiser Permanente as a nurse, you'll help us boldly transform care while also building a career that offers more opportunities for you to grow.
Experience nursing excellence
At Kaiser Permanente our nurses are leaders, clinicians, researchers, innovators, scientists, and more. It takes an extraordinary team to offer extraordinary care.
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