Integrity and Compliance Auditor

Position Status:

Full time

Shift:

First Shift (Days - Less than 12 hours per shift) (United States of America)

Hours per week:

40

Job Information
Exemption Status: Exempt

A Brief Overview
Completes internal healthcare audits for compliance or medical coding, including documentation, billing and regulatory review. Assists with coordination of annual physician reviews with department leaders and third-party vendor. Performs operational and financial audits to identify and correct internal control weaknesses, cost saving situations, and wasteful expenditures. Conducts or assists in health care fraud, waste and abuse investigations when necessary.

Education Qualifications

• Bachelor's Degree Accounting or related field. Required
• Master's Degree Preferred

Experience Qualifications

• 3 years Experience in accounting and/or auditing with focus on revenue cycle, healthcare coding, billing and documentation. Required
• Internal audit (financial, process audits) related experience. Preferred

Skills and Abilities

• Has a detailed understanding of all third-party, Medicare, Medicaid and other federal health insurance programs rules, regulations, policies and procedures. (Preferred proficiency)

Licenses and Certifications

• Certified Professional Coder - AAPC Preferred
• Certified Coding Specialist (CCS) - AHIMA Preferred

What you will do

• Works with leadership to identify policy, coding, billing and related compliance education needs for providers, nurses, and coders as well as facilitates team member participation in educational activities. Develops and conducts education and training to relevant stakeholders as a result of audits.
• Assists with the risk assessment deployment, performance and analysis. Assists in the development, implementation, and maintenance of the annual audit plan performed by third-party vendors. Reviews and appraises the soundness, adequacy, and application of financial and operating controls.
• Assesses the efficiency of resource use. Identifies wasteful expenditures, over payments, revenue enhancements and initiates recovery. Coordinate and oversee efforts to recover erroneous payments made because of misrepresentative billing, fraud, or abuse. Makes recommendations for corrective actions and implements corrective actions when requested.
• Assists with interviews and obtains written statements. Calculates the dollar value of losses. Documents the conclusions reached. Recommends specific steps to prevent recurrence of similar events.
• Prepares statements and either verbal or written reports/updates. Produces documentable audits and investigation findings. Conducts audits to identify patient care and satisfaction issues and makes recommendations for improvement.
• Prepares audit reports; presents findings in exit conferences as appropriate. Communicates to relevant parties the results of audit activity. As appropriate, facilitates development of an action plans, and monitors progress, via continuing audits, and coordinating, education, until satisfactory improvement is achieved.
• Participates in performance/quality improvement activities and patient safety activities. Assists in maintaining compliance with all regulatory agencies. Trends Integrity Helpline calls, Compliance Communication Log, revenue and coding compliance issues, Education Log and other sources to identify education opportunities.
• Serves as a liaison between the Charge and Payment Compliance Coordinators, clinical departments, and physicians, Clinic Coding Services, and the Revenue Cycle team. Performs ongoing audits to ensure patient charges and third-party payer payments are supported by medical documentation, and in accordance with coding and charging regulations, rules and policies.
• Trends audit results and provide clear concise reporting to Integrity & Compliance Committee, Revenue Cycle Leadership Team, Clinical Department Directors, Providers and Administration.
• Informs management in a timely manner of any known or suspected overcharging, undercharging, payer overpayments and payer underpayments.
• Participates in the monthly OIG Work Plan review for potential compliance, coding or medical documentation risks.
• Works jointly on the integrity of the Charge Data Master and ties to the clinical documentation modules. Works jointly with the Clinic Coding Services Educators and Director to ensure education provided, when necessary or requested.
• Performs research to understand other audit related issues, e.g. financial rules.
• Supports Internal Audit and Privacy function on relevant audits, process reviews and special projects. Assist in Integrity & Compliance team investigations, interviews and education. Promotes cooperative and collaborative relations. Maintains confidentiality of patient, employee and corporate information.
• Reads and comprehends newsletters and correspondence received from CMS, Medicare Contractor, Kansas Medical Assistance Program and other third-party payors to keep abreast of new regulations, policies, and payment methodologies.

Required for All Jobs

• Complies with all policies, standards, mandatory training and requirements of Stormont Vail Health
• Performs other duties as assigned

Patient Facing Options

• Position is Not Patient Facing

Remote Work Guidelines

• Workspace is a quiet and distraction-free allowing the ability to comply with all security and privacy standards.
• Stable access to electricity and a minimum of 25mb upload and internet speed.
• Dedicate full attention to the job duties and communication with others during working hours.
• Adhere to break and attendance schedules agreed upon with supervisor.
• Abide by Stormont Vail’s Remote Worker Policy and will review and acknowledge the Remote Work Agreement annually.

Remote Work Capability

• Hybrid

Scope

• No Supervisory Responsibility
• 
  
• No Budget Responsibility No Budget Responsibility

Physical Demands

• Balancing: Rarely less than 1 hour
• Carrying: Rarely less than 1 hour
• Climbing (Stairs): Rarely less than 1 hour
• Driving (Automatic): Rarely less than 1 hour
• Eye/Hand/Foot Coordination: Frequently 3-5 Hours
• Feeling: Occasionally 1-3 Hours
• Grasping (Fine Motor): Occasionally 1-3 Hours
• Grasping (Gross Hand): Occasionally 1-3 Hours
• Handling: Occasionally 1-3 Hours
• Hearing: Frequently 3-5 Hours
• Kneeling: Rarely less than 1 hour
• Lifting: Occasionally 1-3 Hours up to 10 lbs
• Pulling: Occasionally 1-3 Hours up to 10 lbs
• Pushing: Occasionally 1-3 Hours up to 10 lbs
• Reaching (Forward): Rarely less than 1 hour up to 10 lbs
• Reaching (Overhead): Rarely less than 1 hour up to 10 lbs
• Repetitive Motions: Frequently 3-5 Hours
• Sitting: Continuously greater than 5 hours
• Standing: Occasionally 1-3 Hours
• Stooping: Rarely less than 1 hour
• Talking: Frequently 3-5 Hours
• Walking: Occasionally 1-3 Hours

Working Conditions

• Noise/Sounds: Rarely less than 1 hour

Stormont Vail is an equal opportunity employer and adheres to the philosophy and practice of providing equal opportunities for all employees and prospective employees, without regard to the following classifications: race, color, ethnicity, sex, sexual orientation, gender identity and expression, religion, national origin, citizenship, age, marital status, uniformed service, disability or genetic information. This applies to all aspects of employment practices including hiring, firing, pay, benefits, promotions, lateral movements, job training, and any other terms or conditions of employment.

Retaliation is prohibited against any person who files a claim of discrimination, participates in a discrimination investigation, or otherwise opposes an unlawful employment act based upon the above classifications.