Employee is responsible for coordinating, supervising and/or performing compliance audits as per the Compliance Audit Methodology, up to and including the audit report, as assigned and prioritized by the Compliance Audit Workplan and/or the Director of Compliance Audit.
Required: Bachelor's Degree in Accounting, Finance, Business Administration or a Healthcare related field (i.e. Nursing, Health Information Management, Health Information Technician) from an accredited program.
Six or more years experience with a hospital in a progressive internal audit / compliance audit and/or Revenue Cycle department or with a public accounting / consulting firm in a hospital Internal / Compliance auditing role. Significant exposure to Hospital coding (i.e. MS-DRG, APC, ICD-9/HCPS/CPT, etc.) and CMS reimbursement principles, claims processing and healthcare compliance concepts is required.
Three or more years of supervisory experience, preferably within an audit department.
Experienced in researching Federal, State & EHS's healthcare compliance, hospital coding and reimbursement guidelines and regulations.
Microsoft Excel & Word intermediate level of experience is required.
Hospital inpatient and outpatient coding experience (i.e. MS-DRG, APC, ICD-9/HCPS/CPT, etc.). Experienced in compliance and hospital claims auditing / monitoring and with RAT-STATS Statically Valid Random Sampling methodologies.
Knowledge of the 3M coding suite of products, the GE Centricity products, and the Seimens Invision programs.
Knowledge of Microsoft Access, Visio, data mining tools & data analysis.
Position Requirement(s): License/Certification/Registration
Required: At least one of the following, Certified Public Accountant (CPA), Registered Health Information Administrator (RHIA),Registered Health Information Technician (RHIT), Certified Professional Coder- Hospital (CPC-H), Certified Coding Specialist (CCS) certification, or Certified in Healthcare Compliance (CHC), and Certified Internal Auditor (CIA) or able to obtain additional certification(s) within 12 -18 months.
Preferred: Certified Professional Coder (CPC) or Certified Coding Specialist (CCS-P).
Department Position Summary:
Supervise and/or perform compliance audits as per Compliance Audit Methodology including the following:
Perform or supervise development & execution of claims data mining queries and analysis.
Perform or supervise Statistically Valid Random Sampling (SVRS) using the RAT STAT system.
Develop and/or review audit programs to meet scope and objectives as per audit plan.
Research and apply appropriate Federal, State, and EHS's regulatory and coding guidelines required to perform specific audit.
Review audit results to determine the completeness and accuracy of work papers to support audit procedures performed and results, application of Federal, State, and EHS's regulatory reimbursement guidelines including determination of Medical Necessity as per InterQual guidelines and/or other regulatory guidance documents or guidelines related to the medical necessity of patient stays.
Identify and/or facilitate communications with relevant EHS resources as required to perform audit;
Prepare or review draft audit report;
Facilitate audit exit meetings.
Ensure corrective actions recommended are timely, practical and relevant.
Maintain and supervise various audit systems relied upon for the planning, monitoring and reporting of audit projects.
Provide feedback on personnel performance reviews and development.
Assist in the on-boarding process of new personnel.
Supervise audit resources for those projects assigned.
Ensure assignments are completed on time and on budget.
Promote Compliance Auditing best practices and solutions.
Perform or supervise other audit projects as assigned.
Mission: To improve the health of people we touch
Vision: To be recognized locally, regionally and nationally as a premier health system
R.E.S.P.E.C.T.: We will fulfill the mission and vision by adhering to the Standards of R.E.S.P.E.C.T.