Public Health Clinical Internal Auditor

State of Tennessee

Nashville

Government


Position Description / Responsibilities

The Tennessee Department of Health is seeking a Nurse Practitioner for the position of Public Health Clinical Internal Auditor. This is a preferred service position in the Office of Compliance & Ethics. The duties for this position involve conducting in-depth coding and documentation reviews of medical records and payment data to support claims billed, identifying areas in need of improvement, and reporting instances of non-compliance to improve the quality of clinical services provided by the Tennessee Department of Health.

 

We are seeking applicants who will be adept at working in a dynamic, team-focused environment who possess:

 

Duties include:


Position Requirements

The applicant must be licensed as an APN in Tennessee or in a compact state. Occasional travel within the state (less than 25% annually) may be required. Familiarity with information technology solutions such as SAP, PeopleSoft, SQL, Access, SharePoint and ACL is encouraged. Clinical Experience and familiarity with the structure of clinical services recommended.


The Tennessee Department of Health is an equal opportunity, equal access, affirmative action employer.

70%

- Plan, organize, and conduct in-depth coding and documentation evaluations of medical records and payment data to support claims billed and identify aggregate data for outliers and exceptions to ensure adherence with Department of Health's Office of Quality Improvement (quality control) standards, guidelines and protocols.

- Review patient charts/cases for patient health status, findings, lab reports, diagnoses and plans of care in order to determine if appropriate coding is applied and regulations of the Department of Health outlined in the professional standard board document are adhered to and compliant.

- Identify areas that need improvement and report on instances of non-compliance.

- Work closely with various internal agencies that employ bi0lling and coding practices and other stakeholders across the Department to improve efficiency and quality of coding/billing.

- Support the Internal Audit function and participate in special projects as needed.

30%

- In order to make clinical case assessments, incumbent must have and use unique knowledge of medical terminology, billing/coding procedural guidelines (ICD-9 & 10, CPT, HCPCS and CDT) and clinical documentation.

- Must also have knowledge of TennCare/Medicaid/Private Insurance billing and claims processing, and possess strong technical and analytical skills.

- Must have knowledge of CPRS/VISTA and/or PTBMIS programs, Tennessee Public Health Nursing Protocols, and federal programs supported by rural and metro health departments including HIV/TB, WIC, and Immunization, including clinical requirements of those programs.

- Familiarity with information technology solutions such as SAP, PeopleSoft, SQL, Access, SharePoint and ACL.  Will utilize advanced clinical experience and familiarity with the structure of clinical services recommended to make determinations.


Application Instructions

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