Inpatient Coding Compliance Auditor - FT - Days - MSS - Remote Eligible

Memorial Healthcare

1d•Remote

About The Position

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Summary: The Compliance Auditor is responsible for implementing and promoting Memorial’s Compliance Audit Plan to assist the Director of Compliance in reviewing and in ensuring compliance with federal and state laws while affirming organizational commitment to honesty and integrity in all phases of corporate conduct and to assist executive management by performing compliance audits based on the Annual Compliance Work Plan and the special requests of the Chief Executive and other Administrative Officers.

Requirements

Bachelors: Nursing (Required)
Registered Nurse Compact License (RN LICENSE COMPACT) - Compact RN Multistate
Registered Nurse License (RN LICENSE) - State of Florida (FL)
Complexity of Work: This role requires critical thinking skills, effective communication including public speaking and written communication skills, decisive judgment, and the ability to build and foster positive relationships. The incumbent must be able to lead others and take appropriate action when required. Knowledge of Federal, State and Managed Care rules and regulations, knowledge of legal principles. Must be team oriented and self-motivated. Must have basic computer skills such as word processing and spreadsheet abilities. Must have strong management, analytical, conflict resolution and group facilitation skills.
Five (5) years experience in a regulated environment in positions of progressive responsibility.
Two (2) years of auditing within a regulated environment.

Responsibilities

Responds to formal inquiries to the Compliance Hotline to ensure compliance with all laws, regulations, stated policies and procedures.
Responds to formal inquiries from other Departments within the System to ensure compliance with all laws, regulations, stated policies and procedures.
Participates in investigations and responds to questions, issues, reports and formal inquiries by federal and state agencies of possible violations or non-compliance matters raised by employees, patients, physicians and the public.
Assesses and, if necessary, investigates and responds to formal inquiries by federal and state agencies as well as matters of non-compliance raised by employees, patients, physicians and the public.
The Compliance Auditor is responsible for conducting audits of the System’s compliance with laws and regulations established by the Centers of Medicare and Medicaid Services and the Agency for Health Care Administration.
The Compliance Auditor is expected to examine and analyze patient medical records to confirm that documentation supports medical necessity, appropriateness of services provided, coding and the services charged and billed.
Compliance Auditor assists in monitoring compliance with state and federal laws and the System's Policies and Procedures to identify deviations and recommend corrective action to the System's Chief Executive Officer.
Audits are performed in accordance with accepted standards and reports all pertinent findings based on the outcome of the audit.
Compliance Auditor prepares formal written audits reports for executive management that include audit methodology, findings of any deviations, inaccuracies or irregularities, and recommendations to correct identified non-compliance.
Compliance Auditor provides the Chief Compliance and Internal Audit Officer with written reports of findings and recommendations on a timely basis.
Compliance Auditor interacts with legal counsel to discuss the organization's initiatives on regulatory compliance.
Compliance Auditor monitor audit recommendations and retest departments that were previously audited using a smaller sample of transactions to ensure that recommended changes have been implemented and are effective.
Communicates with and educates employees on the Memorial Healthcare System (MHS) Compliance Program Assists in the providing employee training seminars in accordance with the Compliance Policy on Employee Training Policies and Procedures.
Compliance Auditor achieves and maintains proficiency in federal and state regulations; attends seminars; compiles and analyzes laws, regulations and interpretive materials.
Meets and participates in quarterly Compliance Working Committee to ensure that the compliance process is functioning as required.