The rewards at Healogics are immense, starting with the important work we do to change patients’ lives. We also understand that meaningful work is hard work, and we are committed to supporting and compensating our employees for the tremendous service they provide.
 

Think you are a great fit? Learn more about this role here:

Healogics is the largest provider of advanced wound care services in the United States, treating more than 300,000 chronic wound patients annually across over 600 sites. With an aging society, obesity and diabetes on the rise, and an uptick in surgical procedures, the number of patients with non-healing wounds that would benefit from expert care is dramatically increasing. As a result, the company is working to provide our differentiated, quality outcomes to as many patients that would benefit through our out-patient clinic partnerships.

The Compliance Nurse Auditor helps to promote and administer Healogics’ Compliance program, and ensure delivery of high-quality patient care, by conducting medical necessity and medical record documentation reviews and audits. This position also performs other duties related to these primary functions.

All Healogics employees must perform their job responsibilities according to all Healogics policies, Hospital policies, as well as to accrediting organizations, federal and state regulation, and to the Centers for Medicare and Medicaid Services (CMS) guidelines, as applicable.

** This position is either located in Jacksonville, Florida, or can be home-based. **

Essential Functions/Responsibilities:  

Conducts various medical necessity and documentation reviews and audits using designated audit and review tools

Reviews the protocols used in the wound care and hyperbaric oxygen therapy (HBOT) treatments against the established criteria

Maintains the documentation of clinical record audits and reviews in data software

Assists in the preparation and presentation of clinical documentation monitoring/trending reports for review with physicians and leadership

Participates in completion of special projects, as assigned

Communicates with and updates leadership about assigned projects and audits

Provides assistance and guidance to other Clinical Compliance Specialists and serves as a clinical resource/expert for the Compliance Department and Healogics’ Wound Care Centers

Provides training and education of coding, documentation, and regulatory compliance requirements to Healogics providers and others

Performs other duties as required

Required Education, Experience and Credentials:

Current RN (Registered Nurse) or NP (Nurse Practitioner) license

ADN or ASN (Associate’s Degree in Nursing/Associate of Science in Nursing Degree)

BSN (Bachelor’s in Nursing) preferred

Minimum five years’ experience in nursing or in clinical auditing - or combination of equivalent experience

Experience working with a MAC (or predecessor), RAC, ZPIC or UPIC preferred

Experience in wound care services or HBOT preferred

Required Knowledge, Skills and Abilities:

Working knowledge of ICD-10 coding preferred

Demonstrated ability to review medical records using established criteria

Working knowledge and understanding of billing, coding, and reimbursement regulations related to wound care or HBOT, as well as of regulatory changes and payer updates - to be maintained for position.

Working knowledge of latest HBOT techniques and wound care coverage criteria

Ability to work in fast paced environment and to work on multiple projects at the same time

Ability to work with confidential materials and to maintain confidentiality

Organization, prioritization and time management skills

Strong analytical skills and problem-solving skills

Strong attention to detail and accuracy

Strong customer service skills

Strong Interpersonal, oral and written communication skills

Ability to work with others and in a team environment

Proficient in Microsoft Office (Excel, Word, Outlook) and SharePoint

This range is an estimate, based on potential employee qualifications: education, experience, geography as well as operational needs and other considerations permitted by law. 

If you are a current employee, to submit a job application, you need to apply as an internal candidate in Workday via the “Jobs Hub”.