Integrity and Compliance Auditor - Integrity & Compliance - FT - Day

Stormont-Vail HealthCare•Topeka, KS

About The Position

Completes internal healthcare audits for compliance or medical coding, including documentation, billing and regulatory review. Assists with coordination of annual physician reviews with department leaders and third-party vendor. Performs operational and financial audits to identify and correct internal control weaknesses, cost saving situations, and wasteful expenditures. Conducts or assists in health care fraud, waste and abuse investigations when necessary.

Requirements

Bachelor's Degree Accounting or related field. Required
3 years Experience in accounting and/or auditing with focus on revenue cycle, healthcare coding, billing and documentation. Required

Nice To Haves

Master's Degree Preferred
Internal audit (financial, process audits) related experience. Preferred
Has a detailed understanding of all third-party, Medicare, Medicaid and other federal health insurance programs rules, regulations, policies and procedures. (Preferred proficiency)
Certified Professional Coder - AAPC Preferred
Certified Coding Specialist (CCS) - AHIMA Preferred

Responsibilities

Works with leadership to identify policy, coding, billing and related compliance education needs for providers, nurses, and coders as well as facilitates team member participation in educational activities.
Develops and conducts education and training to relevant stakeholders as a result of audits.
Assists with the risk assessment deployment, performance and analysis.
Assists in the development, implementation, and maintenance of the annual audit plan performed by third-party vendors.
Reviews and appraises the soundness, adequacy, and application of financial and operating controls.
Assesses the efficiency of resource use.
Identifies wasteful expenditures, over payments, revenue enhancements and initiates recovery.
Coordinate and oversee efforts to recover erroneous payments made because of misrepresentative billing, fraud, or abuse.
Makes recommendations for corrective actions and implements corrective actions when requested.
Assists with interviews and obtains written statements.
Calculates the dollar value of losses.
Documents the conclusions reached.
Recommends specific steps to prevent recurrence of similar events.
Prepares statements and either verbal or written reports/updates.
Produces documentable audits and investigation findings.
Conducts audits to identify patient care and satisfaction issues and makes recommendations for improvement.
Prepares audit reports; presents findings in exit conferences as appropriate.
Communicates to relevant parties the results of audit activity.
As appropriate, facilitates development of an action plans, and monitors progress, via continuing audits, and coordinating, education, until satisfactory improvement is achieved.
Participates in performance/quality improvement activities and patient safety activities.
Assists in maintaining compliance with all regulatory agencies.
Trends Integrity Helpline calls, Compliance Communication Log, revenue and coding compliance issues, Education Log and other sources to identify education opportunities.
Serves as a liaison between the Charge and Payment Compliance Coordinators, clinical departments, and physicians, Clinic Coding Services, and the Revenue Cycle team.
Performs ongoing audits to ensure patient charges and third-party payer payments are supported by medical documentation, and in accordance with coding and charging regulations, rules and policies.
Trends audit results and provide clear concise reporting to Integrity & Compliance Committee, Revenue Cycle Leadership Team, Clinical Department Directors, Providers and Administration.
Informs management in a timely manner of any known or suspected overcharging, undercharging, payer overpayments and payer underpayments.
Participates in the monthly OIG Work Plan review for potential compliance, coding or medical documentation risks.
Works jointly on the integrity of the Charge Data Master and ties to the clinical documentation modules.
Works jointly with the Clinic Coding Services Educators and Director to ensure education provided, when necessary or requested.
Performs research to understand other audit related issues, e.g. financial rules.
Supports Internal Audit and Privacy function on relevant audits, process reviews and special projects.
Assist in Integrity & Compliance team investigations, interviews and education.
Promotes cooperative and collaborative relations.
Maintains confidentiality of patient, employee and corporate information.
Reads and comprehends newsletters and correspondence received from CMS, Medicare Contractor, Kansas Medical Assistance Program and other third-party payors to keep abreast of new regulations, policies, and payment methodologies.
Complies with all policies, standards, mandatory training and requirements of Stormont Vail Health
Performs other duties as assigned