The Compliance Auditor is a member of the OCCP with general duties and responsibilities related to implementing the Compliance & Privacy Program for all the hospitals in the Steward Health Care System (Steward). This position reports to the Vice President, Compliance and Privacy Officer. The Compliance Auditor needs to be a person of high integrity, and any other duties assigned should not conflict with the Steward’s compliance program goals and objectives. This position will be based in the OCCP’s Corporate office in Richland, TX and will require travel to the other Steward locations from time-to-time. This position will part of a team of Compliance Auditors who perform compliance auditing and monitoring of hospital inpatient and outpatient services as well as other clinics billed to Medicare, Medicaid and other third-party payers. The compliance audit schedule for this team is based on an annual Compliance Work Plan.
- Performs hospital and clinic revenue integrity as well as compliance audits based on the annual Compliance Work Plan, as assigned. Assists in performing other compliance audits or investigations as requested. Produces well-written, accurate draft audit reports for review by the Vice President Compliance and Privacy Officer on a timely basis.
- Schedules meetings with appropriate department managers to discuss audit initiation and wrap-up. Consults with senior management and staff upon the conclusion of audits, both orally and in writing, to describe observations and recommend corrective action to remediate issues identified and enhance compliance, as instructed.
- Assists in the retrieval of data to assist department directors/managers in accomplishing the objectives of compliance, as may be necessary.
- Ensures quality assurance through participation in an internal peer review process on each compliance audit.
- Maintains documentation of methods used and individuals involved in verifying compliance; documented identified issues, corrective actions taken, and improvements implemented. Assists in implementing leading practices for audit working paper documentation, security, and retention.
- Provides recommendations to improve documentation, coding or billing practices, correct any discrepancies discovered during audits, and prevent reoccurrence.
- Assists with monitoring the implementation status of management’s corrective action plans in response to identified compliance audit issues, as assigned.
- Assists with the development and delivery of compliance training programs, as assigned.
- Logs identified issues in the OCCP database accurately and timely.
- Interacts with employees at all levels, demonstrating impartiality and fairness at all times.
- Establishes and retains a cooperative relationship with Medicare Administrative Contractors and others to understand applicable Medicare and other third-party payor requirements, as assigned.
- Demonstrates a knowledge and understanding of Steward’s policies and procedures and applicable regulatory requirements. Maintains a library of appropriate reference material that will facilitate the understanding of and compliance with applicable requirements.
- Establishes effective working relationships and builds credibility within the Steward hospitals and clinics to support a culture of compliance.
- Identifies potential risk areas on an ongoing basis and assists the Steward hospitals with developing risk mitigation and/or corrective action plan strategies.
- Under the direction of the Senior Vice President, Chief Compliance Officer and the Vice President of Compliance and Privacy, acts as a consultative resource on issues concerning compliance, and provides recommendations to enhance policies, procedures and internal controls as needed.
- Cooperates with the regulators (e.g., CMS, OIG, OCR, State Attorney General, etc) and other parties, as appropriate, in connection with any privacy or compliance inquiries, audits or investigations.
- Participates in health care compliance and coding related professional organizations to stay abreast of compliance developments and leading industry practices.
- Represents the OCCP through participation in various Steward committees and work groups, as assigned.
- Participates in periodic OCCP team meetings in order to ensure effective communication.
- Maintains time and effort reporting records as assigned.
- Demonstrates respect and regard for the dignity of all patients, families, visitors, and fellow employees to ensure a professional, responsible, and courteous environment. (1) Commits to recognize and respect cultural diversity for all customers (internal and external) and (2) Communicates effectively with internal and external customers with respect of differences in cultures, values, beliefs and ages, utilizing interpreters when needed.
- Performs other duties as assigned
REQUIRED KNOWLEDGE & SKILLS:
- Strong working knowledge of hospital inpatient and/or outpatient coding and billing compliance required (ICD-9, DRG, CPT, etc.).
- Working knowledge of Medicare/Medicaid/commercial/managed care payment systems for hospitals.
- Knowledge of health care management in terms of financial and billing concepts
- Familiarity with federal and state privacy laws and regulations required.
- Familiarity with operational, financial, and information technology security procedures and regulations a must.
- Strong oral/written communication and presentation skills a must.
- Strong leadership, organizational, interpersonal and analytical skills and the ability to function effectively in a fast-paced environment.
- Ability to prioritize and plan work independently.
- Ability to interact with employees at all levels.
- Effectively work with and coordinate the activities of external consultants and legal counsel, as assigned.
- Ability to anticipate potential issues and proactively respond. · Good judgment and problem-solving skills.
- Team player.
- Ability to maintain confidentiality
I. Education: A bachelor’s degree is preferred.
II. Experience: A minimum of 5 years experience in a health care. Prior experience as a hospital compliance auditor preferred.
III. Certification/Licensure: Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) preferred. Additional specialty coding certifications (e.g., CDI, CCS-P, ICD-10) desired. Certification in Healthcare Compliance (CHC) certification required or must be obtained within one year of hire.
IV. Software/Hardware: Microsoft Outlook, Word, Excel, Internet Explorer and PowerPoint Skills Required. Microsoft Access Skills preferred. Ability to effectively navigate electronic health records and physician billing systems is required. Ability to research applicable Medicare, Medicaid and other compliance requirements is required.
V. Other: Travel Requirements: The ability to travel regionally and nationally. Must have a valid driver's license, provide own transportation, and be able to travel to Steward locations using a variety of modes of transportation.