Hospital Revenue Integrity Auditor - Compliance
- Plans and performs hospital and allied services revenue integrity audits based on the annual Revenue Integrity Audit Plan, as assigned.
- Assists in performing other compliance audits or investigations as requested. Produces well-written, accurate audit reports for review by the Vice President, Compliance & Privacy Operations on a timely basis.
- Schedules meetings with appropriate department managers to discuss audit initiation and wrap-up. At the direction of the Vice President, Compliance & Privacy Operations, consults with senior management and staff upon the conclusion of audits, both orally and in writing, to describe observations and recommend corrective action to remediate issues identified and enhance compliance.
- Assists in the retrieval of data to assist department directors/managers in accomplishing the objectives of compliance, as necessary.
- Ensures quality assurance through participation in an internal peer review process on each compliance audit.
- Maintains documentation of methods used and individuals involved in verifying compliance; documented identified issues, corrective actions taken, and improvements implemented. Assists in implementing leading practices for audit working paper documentation, security, and retention.
- Provides recommendations to improve documentation, coding or billing practices, correct any discrepancies discovered during audits, and prevent reoccurrence.
- Assists with monitoring the implementation status of management's corrective action plans in response to identified compliance audit issues as assigned.
- Assists with the development and delivery of compliance training programs as assigned.
- Demonstrates a knowledge and understanding of Steward's policies and procedures and applicable regulatory requirements. Maintains a library of appropriate reference material that will facilitate the understanding of and compliance with applicable requirements.
- Establishes effective working relationships and builds credibility within applicable Steward entities to support a culture of compliance.
- Strong working knowledge of hospital inpatient and/or outpatient coding and billing compliance required (ICD-10, DRG, CPT, etc.).
- Strong working knowledge of Medicare/Medicaid/commercial/managed care payment systems for hospitals.
- Knowledge of health care management in terms of financial and billing concepts
- Familiarity with federal and state privacy laws and regulations required.
Education: A bachelor's degree required; 5 years or more of auditing experience may be substituted for a degree.
Experience: A minimum of 5 years' experience in a health care. Prior experience as a hospital compliance auditor preferred.
Certification/Licensure: Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) a plus. Certification in Healthcare Compliance (CHC) certification a plus.
Software/Hardware: Microsoft Outlook, Word, Excel, Internet Explorer and PowerPoint Skills Required. Microsoft Access Skills preferred. Ability to effectively navigate electronic health records and physician billing systems is required. Ability to research applicable Medicare, Medicaid and other compliance requirements is required.
Job Reference #: 45833