Clinical Auditor in Fort Washington, Pennsylvania at Acts Retirement-Life Communities

Date Posted: 1/3/2020

Job Snapshot

Job Description

Join our team at Acts Retirement-Life Communities! Acts has been setting the standard for excellence in senior retirement living since 1972, with a vision founded in faith and guided by a commitment to integrity and loving kindness.

Summary Statement:  Reporting to the Director of Clinical Assessment Standards and Compliance to assess corporate and community compliance for Medicare, Medicaid, HIPAA, Hospice, Home Health and other healthcare related areas with internal and regulatory policies and procedures, report findings and provide recommendations for improvement. Maintains processes and systems to ensure the timely monitoring of compliance in both the healthcare setting and other operational settings.


Essential Job Functions:

1. Complete audits for Medicare (A&B) and Medicaid chart documentation, billing compliance and medical necessity at each of our communities.
2. Complete assessments for policy and regulatory compliance with other healthcare related functions.
3. Update audit forms and procedures as needed with regulatory/policy changes.
4. Assist in development of processes and systems to ensure timely monitoring of compliance in both the healthcare setting and other operational settings.
5. Writes and submits reports to community contacts and management on a regular basis with findings and recommendations.
6. Ensures work is completed timely and adheres to professional standards.
7. Performs other duties as assigned.

Job Requirements

Education & Experience:

The critical skills and knowledge required to successfully perform the functions of the position are normally obtained thru:
- Education Level: Licensed RN or Therapist (PT/OT/ST) with Bachelor’s Degree, preferably in a healthcare related field
- Years of Relevant Work Experience: Three (3) year’s work experience in skilled nursing or similar setting with Medicare and Medicaid, including thorough knowledge of CMS guidelines and regulations and knowledge of the MDS and RAI process.

Critical Skills and Necessary Knowledge:

- Communication and Interpersonal Skills (must be able to work well in a team-oriented environment).
- Excellent written, verbal and grammatical skills within the English language.
- Exceptional customer service, quick evaluation and decision making.
- Excellent computer software knowledge (MS Word, Excel, Outlook, Electronic Medical Record Software).
- Ability to analyze, interpret, and report financial information.
- Must be able to meet deadlines as required.
- Can operate all office equipment (including telephone, computer, copier).
- Work efficiently with minimal supervision.

Environmental Conditions
• Office
• Frequent Travel