Description
Minimum QualificationsEducation: Bachelors of Nursing required. Masters of Business or Healthcare Administration preferred.
Licenses/Certifications: Current and valid license to practice as a Registered Nurse in the state of Texas.
Experience / Knowledge / Skills:
Minimum five (5) years experience in finance, operations, audit, or consulting with a hospital or managed care focus
Minimum five (5) years clinical experience; preferably critical care
Knowledge of the American Association of Medical Audit Specialists standards and TJC Core Measures as appropriate
Knowledge of Medicare/Medicaid regulations
Excellent analytical, critical thinking, communication, and interpersonal skills
Strong PC skills including Word, Excel, and Access
Application development experience and a working knowledge of ERP software (e.g. Lawson, SAP, etc.) highly preferred.
Principal Accountabilities
Coordinates and implements billing and quality audits based on medical audit standards as promoted by the American Association of Medical Audit Specialists standards, as well as quality audits using TJC Core Measures standards.
Supports the Director of the department in the implementation and ongoing monitoring of the clinical audit program.
Establishes and maintains good professional rapport with insurance companies, physicians and staff while obtaining necessary data.
Benchmarks various departments across Memorial Hermann both internally and externally using various financial and operating statistics.
Develops methods and strategies for testing the integrity of newly deployed clinical programs.
Assesses new material risks, both financial business and compliance risks, making recommendations and implementing changes to ensure Memorial Hermann’s interests are protected and exposure is minimized.
Prepares written reports and oral presentations for various committees and executive personnel including audit reports identifying trends or gaps in practice to effect change.
Assures proper confidentiality and complies with HIPAA guidelines.
Coordinates findings of billing audits with insurance companies as appropriate.
Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
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.
Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.
Other duties as assigned.
RN - Senior Clinical Auditor - Operating Room • Southeast Hospital
Clinical Specialist (Florida Region).Two areas where Verathon has significantly impacted patient care, and become the market leader in each, are bladder volume measurement and airway management.The...[internal_linking.show_more]
Join Davies Risk Services as a Premium Auditor — No Experience Required!.Are you a self-starter who thrives on independence, loves working with numbers, and enjoys meeting new people?.Do you have a...[internal_linking.show_more]
Sr Auditor, Corp Compliance Hybrid.Hybrid schedule 2 days in office on Tuesdays and Wednesdays at either the Denver, CO or Federal Way, WA office.Denver, CO, US Federal Way, WA The Senior Auditor o...[internal_linking.show_more]
Training ManagerThis job delivers highly complex clinical and systems training courses, ongoing workshops in support of workforce development, technology and / or proprietary business systems, upda...[internal_linking.show_more]
Registered Nurse (RN) | Cardiovascular Operating Room.TravelNurseSource is working with Lancesoft Inc to find a qualified CVOR RN in Everett, Washington, 98201!.Facility : Providence Regional Medic...[internal_linking.show_more]
LRS Healthcare - Nursing is seeking an experienced Operating Room Registered Nurse for an exciting Travel Nursing job in Tacoma, WA.Shift: Inquire Start Date: 05/04/2026 Duration: 13 weeks Pay: $22...[internal_linking.show_more]
Join Davies Risk Services as a Premium Auditor No Experience Required!.Are you a self-starter who thrives on independence, loves working with numbers, and enjoys meeting new people? Do you have a c...[internal_linking.show_more]
TRS Healthcare is seeking an experienced Operating Room Registered Nurse for an exciting Travel Nursing job in Tacoma, WA.Shift: 3x12 hr days Start Date: 05/18/2026 Duration: 13 weeks Pay: $2371.TR...[internal_linking.show_more]
The Night Auditor is responsible for providing consistent excellent service to guests/clients before arrival, upon arrival, from check-in to checkout and efficient balancing of the day's transactio...[internal_linking.show_more]
Medical Solutions is seeking an experienced Operating Room Registered Nurse for an exciting Travel Nursing job in Seattle, WA.Shift: 4x10 hr days Start Date: ASAP Duration: 13 weeks.A facility in S...[internal_linking.show_more]
Job Summary and Responsibilities This position is responsible for providing professional care specifically to adult, oncology/hematology patients.Work is performed under standards of safety and car...[internal_linking.show_more]
Job Description Accenture is a global leader in professional services, helping organizations worldwide transform their operations, enhance their growth, and deliver sustainable outcomes across indu...[internal_linking.show_more]
Hybrid in office in Denver, CO or Federal Way, WA Tuesdays and Wednesdays.Develops and executes audit programs and testing procedures relevant to risk and test objectives.Ensures audit conclusions ...[internal_linking.show_more]
Join our team at Legacy Hospitality as a Night Auditor and be a vital part of our dynamic hotel operation.As a Night Auditor, you will have the opportunity to showcase your attention to detail and ...[internal_linking.show_more]
Atlas MedStaff is seeking an experienced Cardiovascular Operating Room Registered Nurse for an exciting Travel Nursing job in Tacoma, WA.Shift: 3x12 hr days Start Date: 05/04/2026 Duration: 13 week...[internal_linking.show_more]
Join our Seattle, Washington Team!.PACE Clinical Services Manager (RN).BSN or ADN from an accredited nursing program.Active Registered Nurse (RN) license.Minimum 5 years of nursing experience.At le...[internal_linking.show_more]
Description The Clinical Supervisor RN coordinates and manages the clinical support staff and the clinical workflows and activities within the clinic.This position functions as an integral member o...[internal_linking.show_more]
JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes.Responsible for verifying that services are medically necessary and align with established clini...[internal_linking.show_more]
