Director of Finance and Reimbursement Compliance

Appalachian Regional Healthcare, Inc.•Lexington, KY

4h•Hybrid

About The Position

The Director of Finance and Reimbursement Compliance is the Compliance Department’s subject matter expert and lead financial auditor. The role provides leadership and guidance, recommends work plans, helps identify compliance risks and develop policies and standard operating procedures, and collaborates on corrective action plans for facilities. The Director helps develop system-wide compliance and internal audit functions for ARH hospitals, physicians and non-physician providers, ambulatory services, home services, and other entities. The position designs, plans, and executes coding and billing compliance audits in accordance with regulatory requirements and industry-accepted standards, working collaboratively with departments across ARH, including Finance and Legal. The position is hybrid (remote/on-site), and the employee must reside in Kentucky or West Virginia. Occasional travel of up to 20% may be required.

Requirements

Bachelor’s degree in Accounting or a related field, such as Finance or Business.
At least five years of experience in a healthcare setting, specifically involving reimbursement or financial auditing.
Must currently hold, or obtain within 12 months of hire, one or more of the following: Certified Internal Auditor (CIA), Certified in Healthcare Internal Audit (CHIAP), Certified Fraud Examiner (CFE), or a related certification.
Strong understanding of internal auditing and reimbursement laws.
Ability to research and interpret complex compliance requirements, including state and federal laws and regulations.
Strong analytical skills to assess billing, compliance, and related issues and provide recommendations.
Ability to translate compliance regulations into practical audit tools and audit scope documents.
Excellent communication and collaboration skills.
Demonstrated leadership abilities.
Proficiency in data analysis and reporting tools.
Ability to maintain confidentiality and handle sensitive information professionally.
Ability to manage multiple projects and deadlines simultaneously.
Must reside in Kentucky or West Virginia.

Responsibilities

Develop comprehensive financial audit plans in consultation with other Compliance Department members.
Independently conduct financial audits and requested investigations.
Generate reports and analyze data from databases and software systems across ARH.
Perform and document audit follow-up to monitor ongoing compliance and confirm implementation of requested corrective action plans.
Prepare clear, concise reports with sufficient detail and documentation to support procedures, findings, and conclusions.
Maintain professional competence by staying current with auditing principles, practices, statutes, regulations, and compliance practices.
Apply Internal Audit Standards established by the Institute of Internal Auditors.
Discuss audit results clearly with all levels of management and provide education as appropriate.
Review programs and activities affected by industry regulations and recommend changes to address noncompliant company procedures and practices.
Review the Office of Inspector General’s work plan, develop education from it, and assist in creating compliance audits addressing areas of concentration.
Research and respond to compliance inquiries.
Coordinate with the Chief Compliance & Privacy Officer to develop the Compliance Department’s annual work plan.
Perform complex regulatory, audit, billing, coding documentation, medical necessity, and other compliance analyses to support appropriate hospital reimbursement and compliance with applicable laws, rules, guidelines, and regulations.
Participate in the annual risk assessment and recommend practical process or policy improvements.
Provide education on reimbursement updates as appropriate.
Maintain professional certification.
Perform other duties as assigned.