Job Description

Job Summary:
Establishes effective working relationships and builds credibility within the Steward entities to support a culture of compliance.
  • Identifies potential risk areas and assists the Steward entities with developing risk mitigation and/or corrective action plan strategies.
  • Under the direction of the Executive Director, Compliance & Privacy Operations, acts as a consultative resource on issues concerning billing compliance, and provides recommendations to enhance policies, procedures and internal controls as needed.
  • Plans and performs compliance audits of individual physicians, mid-level practitioners and nurses on documentation, coding and billing requirements and related education activities as assigned.
  • Assists in performing other compliance audits as requested.
  • Produces well-written, accurate draft audit reports for review by the Director, Revenue Integrity Audits on a timely basis.
  • Assists with quality assurance peer review of other team members audit work as assigned.
  • Provides recommendations to improve documentation, coding or billing practices, correct any discrepancies discovered during audits, and prevent reoccurrence.
  • Assists with the development and delivery of compliance training programs as assigned.
  • Logs identified issues in the OCCP database accurately and timely.
  • Works collaboratively with appropriate Steward workforce members to resolve compliance issues as assigned.
  • Monitors the implementation status of management's corrective action plans in response to identified compliance issues as assigned.
  • Assists with investigations of compliance concerns at the assigned Steward entities that are raised through the Compliance Support Line or other communication mechanisms.
  • Bachelor's degree required or at least 5 years of coding/auditing experience.
  • Minimum of 5 years' experience in a health care.
  • Prior experience as a compliance auditor and education instructor preferred.
  • Certified Coding Specialist--Physician-Based (CCS-P) or Certified Professional Coder (CPC) required.
  • Additional specialty coding certifications (e.g., Evaluation and Management, Emergency Department, etc.) desired.
  • 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.
  • Must have a valid driver's license, provide own transportation, and be able to travel to Steward locations

Application Instructions

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