New

Nurse Data Manager Ex

Thomas Jefferson University & Jefferson Health
United States, Pennsylvania, Philadelphia
900 Walnut Street (Show on map)
Jan 13, 2025
Job Details PRIMARY FUNCTION: This position is responsible for performing clinical audits of detailed patient records with an emphasis on the accuracy of charges posted to meet billing compliance requirements. ESSENTIAL FUNCTIONS: * Interacts with co-workers, visitors and other staff consistent with the values of Jefferson. * Completes chart-to-bill audits as requested by customers and/or management, or pursuant to 3rd party payer requests and audit activity. * Improves the performance of charge capture process to include assisting in the development of best practices, coordinating error resolution and establishing prevention measures. * Performs external defensive audits and reports findings to management. * Provides clinical staff billing documentation and billing guidance. Ensures that Jefferson's regulatory guidance documents, policies, and procedures align with all applicable requirements and that members of the community understand how to comply. Manages complaints received from but not limited to: The Joint Commission, Department of Health Centers of Medicare/Medicaid Services Serves as a primary resource for the organization's continuous regulatory compliance, including survey preparation, accreditation and licensure as well as ongoing readiness. Serves as a primary resource for division regulatory leaders to ensure that Jefferson receives and acts upon newly identified regulatory standards and requirements. Services as a liaison to stakeholders who are responsible to address, respond to, investigate, and remediate issues that rise to the level of Department of Health, The Joint Commission, CMS and/ or related agency inquiries. Participates in meetings with internal stakeholders and external business partners or teams to communicate regulatory guidance and strategies. Provide critical review of and support for development of timely responses to regulatory questions and inquiries from external agencies. Job Description* Current Registered Nurse license is required. Advanced degree (Health Care Compliance, Health Care Administration, Population Health, M.S. or Pharm.D.) in scientific, Regulatory Affairs, or related health care field preferred. AND Experience: Minimum of five (5) years of progressively responsible experience in healthcare or related regulatory fields. Experienced leader, with a minimum of 3 years of investigations, regulatory oversight or related experience preferred. Proficiency with compliance technology systems, process design experience and/or active participation in systems-related projects desired. Work Shift Workday Day (United States of America) Worker Sub Type Regular Primary Location Address 601 Walnut Street, Philadelphia, Pennsylvania, United States of America Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years. Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.