The Temporary Compliance Auditor will support several departments throughout the HSC Health Care System and will play a leading role in conducting medical record audits of hospital billing, coding and documentation. Responsibilities include participating in external government audits, identifying compliance risk areas, developing formal audit reports containing findings and recommended solutions, and formulating plans to resolve compliance issues. In addition, the Compliance Auditor will provide extensive training and support to necessary staff to ensure they are familiar with the auditing process and regulatory standards. The candidate will also ensure that regulatory and third party payer requirements and company policies and procedures for medical billing and coding are followed and achieved.
ESSENTIAL JOB-SPECIFIC FUNCTIONS
- Develops and recommends auditing tools and standards that will be used during compliance audits
- Conducts provider-billing audits for network providers in accordance with audit billing procedures. Conducts compliance audits in accordance with the annual Compliance Work Plan. HSCSN: Reviews claims rejections and audits claims review process to identify areas of provider non-compliance. HSCPC: Oversees and monitors implementation of the coding compliance program. Performs documentation and coding validation reviews, including physician coding reviews. Identifies problems and reviews patient charts for accuracy of coding, sequencing and documentation, with particular reference to HIM compliance requirements.
- Assists in conducting risk assessments of the system business practices to determine areas of exposure and to implement remedial and mitigation solutions.
- Prepares clear and well-organized audit work papers that appropriately document the work performed; writes clear and meaningful audit comments and actionable recommendations.
- Performs internal compliance investigations and audits throughout the system, including compiling detailed reports with recommendations to the Chief Compliance Officer and management.
- Performs interviews with all key personnel involved with the investigation to verify compliance with established policies and procedures and applicable regulations.
- Assist in the development and implementation of an effective compliance training and education program, such as appropriate documentation and coding, and educational sessions to all appropriate clinical and non-clinical personnel. Conducts training sessions when requested.
- Assists the Compliance Officer with the development and implementation of the annual Compliance Work Plan.
- Assists in receiving and screening compliance calls to the hotline and complaints directly to the Compliance Department. Investigates and conducts interviews of those individuals reporting potential compliance violations.
- Assists with the development and implementation of policies and procedures relating to the functions of the Compliance department.
- Provides compliance activities/issues report for designated entities within the system to the Compliance Officer on a regular basis.
- Attends mandatory in services and meetings or arranges with the appropriate supervisor for satisfactory compliance.
- Maintains current knowledge in present areas of responsibility (i.e. attends ongoing educational programs).
- Performs other duties as required.
- At least 3years of billing, coding and documentation experience in hospital setting.
- Strong computer skills with knowledge of Microsoft Office and hospital information systems required.
- Knowledge of compliance guidelines related to coding and billing.
- Significant exposure to healthcare concepts, and compliance auditing , a must. License/Certifications: Preferred HIM background and/or coding certification ( i.e. CCS, CPC, RHIA, RHIT, etc)
- Bachelors Degree in Accounting, Finance, Business Administration or Bachelor’s or Associates Degree in a health care field (i.e. Nursing, Health Information Management, Health Information Technician) from an accredited program.
DC Residents are encouraged to apply!