Compliance Nurse Auditor

Who you are:

As a Compliance Nurse Auditor for Johns Hopkins HealthCare, you have that perfect combination of clinical skills and attention to details when it comes to reading, extracting, and understanding a patient’s medical record. You have strong computer skills, along with strong interpersonal, oral, and written communication skills as you report your audit findings to all levels of management and JHHC staff.

What you’ll do:

• Design, plan, and execute compliance audits following regulatory requirements and industry-accepted standards.
  • Audits include, but are not limited to, compliance with contractual requirements, internal audits to verify departmental compliance with JHHC policies, legal, and contractual obligations.
• Draft audit findings, prepare written reports, and summarize audit findings.
• Identify compliance risk areas and assist with the development and implementation of policies and corrective actions

What you’ll bring:

• Ability to read, abstract, and understand a patient’s medical record
  • Strong analytical skills to both assess and report billing, compliance, and related issues
• 3+ years’ clinical experience required
  • Health insurance, hospital, physician practice, or other health care field
• 1+ years’ managed care experience is highly preferred
  • Medical record, coding, and/or billing audit experience strongly preferred.
• Must understand regulatory requirements.
  • Requires a professional level of knowledge of ICD10 CM and PCS, CPT and HCPCS coding terminology.
• Strong computer skills in standard PC word processing, spreadsheet and database applications.
  • Excel and Word
• Associates Degree in Nursing required
  • BSN or other related major preferred
• Active State of Maryland nursing licensure (or a compact state) required, if applicable.

Who we are:

Johns Hopkins HealthCare (JHHC) is the managed care and health services business of Johns Hopkins Medicine. JHHC is a $3B business serving over 500,000 active members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHC is a leader in provider-sponsored health plans and is poised for future growth.

Many organizations talk about transforming the future of healthcare, at Johns Hopkins HealthCare, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHC is the place to call home.

Johns Hopkins Health System and its affiliates are Equal Opportunity / Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.