Compliance Auditor Prof Svcs

Cooper University Hospital•Camden, NJ

About The Position

At Cooper University Health Care, our commitment to providing extraordinary health care begins with our team. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols. We have a commitment to our employees to provide competitive rates and compensation programs. Cooper offers full and part-time employees a comprehensive benefits program, including health, dental, vision, life, disability, and retirement. We also provide attractive working conditions and opportunities for career growth through professional development. Discover why Cooper University Health Care is the employer of choice in South Jersey. The auditor reviews professional fee billing, coding and documentation. Reviews to be performed are identified based on the then-current OIG Workplan and compliance risk analyses. Customers include employed providers, senior leadership, clinical and non-clinical staff of Cooper University Health Care. Under the supervision of the Chief Compliance Officer, auditors are responsible for supporting the corporate compliance program, responsibilities include: Performance of timely and effective compliance and operational reviews to assess coding, documentation and billing accuracy, identify compliance related risks, internal control weaknesses, revenue capture opportunities and assist in determining the root cause of any identified non-compliance with government rules and regulations, state laws and Cooper policies and procedures Preparatory work for reviews/audits including developing a scope of work. Reviewing available documentation. Analyze/review audit data and prepare reports for review and presentation to management, providers and departments, making recommendations for improvement Determine charge corrections and refunds resulting from compliance reviews and ensure they have been completed. Post-review/audit education/training when applicable. Performing follow-up reviews when necessary. Ensuring appropriate work papers, either paper or electronic, are maintained in accordance with regulations/policy Assist in the development of policies and procedures that establish standards for compliance, as well as preparation of other guidance documents and tools to assist Coper providers and staff in appropriate billing, coding and documentation. Serve as liaison for questions, concerns, incidents and complaints regarding compliance matters, responding directly to the inquiry and/or consulting or interacting with other team members or departments. Inform Chief Compliance Officer of major findings; based on types of questions/concerns received, recommend remedial correction and prevention actions; identify education/awareness opportunities and guidance topics Work with all levels within the organization to ensure that internal controls throughout the system provide for accurate, complete and compliance program and processes

Requirements

3+ years’ experience in an academic medical center preferred, with emphasis on provider compliance activities, including but not limited to: auditing, monitoring, investigation and training
Demonstrated knowledge and understanding of provider professional fee billing, coding and documentation practices in inpatient and outpatient settings.
Demonstrated expertise in medical terminology.
Demonstrated expertise in healthcare coding (CPT, ICD-9, ICD-10, APC, HCPCS).
Demonstrated knowledge and understanding of HIPAA rules and regulations affecting the management of confidential protected health information (PHI).
Demonstrated knowledge and understanding of federal and state statutes, laws, rules and regulations affecting billing, coding and documentation practices in support of healthcare services provided to beneficiaries of federally-funded healthcare programs and other third party payers.
Demonstrated knowledge and understanding of the essential elements of an effective compliance program
Working knowledge and understanding of: - provider professional fee revenue cycle and reimbursement. - electronic billing and medical record systems- sampling technologies and statistical analyses
.Experience using personal computers required.
Current certification as a CPC or COC
Valid driver’s license and automobile insurance per company policy

Nice To Haves

Experience using the following applications is desirable: Word, Excel, e-mail, and healthcare related billing systems.
Experience using MDAudit audit software and/or EPIC EMR desirable

Responsibilities

Performance of timely and effective compliance and operational reviews to assess coding, documentation and billing accuracy, identify compliance related risks, internal control weaknesses, revenue capture opportunities and assist in determining the root cause of any identified non-compliance with government rules and regulations, state laws and Cooper policies and procedures
Preparatory work for reviews/audits including developing a scope of work.
Reviewing available documentation.
Analyze/review audit data and prepare reports for review and presentation to management, providers and departments, making recommendations for improvement
Determine charge corrections and refunds resulting from compliance reviews and ensure they have been completed.
Post-review/audit education/training when applicable.
Performing follow-up reviews when necessary.
Ensuring appropriate work papers, either paper or electronic, are maintained in accordance with regulations/policy
Assist in the development of policies and procedures that establish standards for compliance, as well as preparation of other guidance documents and tools to assist Coper providers and staff in appropriate billing, coding and documentation.
Serve as liaison for questions, concerns, incidents and complaints regarding compliance matters, responding directly to the inquiry and/or consulting or interacting with other team members or departments. Inform Chief Compliance Officer of major findings; based on types of questions/concerns received, recommend remedial correction and prevention actions; identify education/awareness opportunities and guidance topics
Work with all levels within the organization to ensure that internal controls throughout the system provide for accurate, complete and compliance program and processes