Principal Compliance Specialist (Auditor/Clinician Educator) (Coding certification required) - HYBRID

Vanderbilt University Medical Center•Nashville, TN

14h•Hybrid

About The Position

Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery, and patient care, VUMC is a community of individuals who come to work each day with the simple aim of changing the world. It is a place where your expertise will be valued, your knowledge expanded, and your abilities challenged. Vanderbilt Health is committed to an environment where everyone has the chance to thrive and where your uniqueness is sought and celebrated. It is a place where employees know they are part of something that is bigger than themselves, take exceptional pride in their work and never settle for what was good enough yesterday. Vanderbilt’s mission is to advance health and wellness through preeminent programs in patient care, education, and research. Applies specialized skills and training independently to evaluate and advise whether professional, outpatient and inpatient hospital documentation meets applicable standards for coverage, accuracy, and completeness as well as coding and general compliance, with the goals of identifying and preventing compliance risk and providing timely and effective education and remediation. Provides hands-on training and day-to-day productivity and quality oversight of Compliance Specialists and Senior Compliance Specialists as well as any external contracted services used by our office for auditing and consulting services. Coding Certification Required... Must have one of the following certs: CPC, CCS, COC, RHIA, RHIT, etc...

Requirements

Coding Certification Required... Must have one of the following certs: CPC, CCS, COC, RHIA, RHIT, etc...
Regulatory Compliance (Advanced): Demonstrates knowledge of the appropriate rules and regulations and apply them in difficult, stressful and complex situations. Able to interpret and explain rules and regulations that are ambiguous or unclear. Directs others in interpreting rules and regulations on the job and trains others in them.
Improvement Methodology (Intermediate): Lead teams in quality and performance improvement methodology, including facilitating opportunity analysis, key driver diagrams, performance measure requirements, and PDSA improvement cycles (EA, FMEA, CTQ)
Data Procurement (Advanced): Seeking, collecting, transforming, and ensuring quality of data.
Metadata Analysis (Advanced): Demonstrates the uppermost levels of expertise in data analysis and interpretation. Works with teams and organization stakeholders to identify new, innovative methods and tools for incorporation into data analysis practices. Is able to design a complex logical data or object model. Is knowledgeable of enterprise-wide data and object models and can identify areas of reuse. Possesses expert knowledge in the use of CASE tools. Can recommend extensions to a data dictionary or repository to support data analysis. Can specify how data should be transformed for new uses such as data warehousing.
Communication (Advanced): Clearly, effectively and respectfully communicates to employees or customers.
Strategic Planning (Intermediate): The ability to define a strategy, or direction, and making decisions on allocating its resources.
Certified Professional Coder-Hospital - American Academy of Professional Coders
Relevant Work Experience Experience Level: 7 years
Bachelor's

Responsibilities

Evaluates internal and external data and documentation to identify patterns, errors, and risk factors, assess potential areas of non-compliance and vulnerability to audit by health oversight agencies and contractors.
Recommends and assists in the scoping, planning, and design of subject matter review and clinician-focused (structured) review projects
Serves in a quality assurance role with responsibility for ensuring that auditing and monitoring performed by other individuals, including third-party consultants, is correct, complete and accurate. Escalates issues or concerns
Performs audits and analyses and assists in the drafting, editing and finalization of OCCI reports resulting from completed subject matter and structured reviews
Research and analyze issues in response to requests for assistance from the OCCI team and from other VUMC stakeholders.
Leads virtual meetings with VUMC clinical and administrative stakeholders to provide education and guidance on documentation, coding, pertinent policy/SOPs, and billing topics.
Independently perform audit reviews of contracts, systems, processes, documentation and billing.
Maintains current knowledge of policy, legal and regulatory standards.
Attends and participates in subject matter review entrance and exit conferences
The responsibilities listed are a general overview of the position and additional duties may be assigned.
Provides hands-on training and day-to-day productivity and quality oversight of Compliance Specialists and Senior Compliance Specialists in the department, as well as any external contracted services used by our office for auditing and consulting services.
Leads efforts to understand, develop and deploy Artificial Intelligence (AI) technology in the review/audit process.
Works with MDaudit and other vendors to help ensure the tools we utilize are continually evaluated for enhancements that will reduce manual intervention in the audit/review process; improve accuracy of findings and enhance educational materials.