Compliance Auditor II

2 months ago

Lexington, United States Addiction Recovery Care Full time
Job DescriptionJob Description

Are you looking for the best place to work?  Join Addiction Recovery Care, LLC (ARC) which was selected as one of the 2024 Best Places to Work in Kentucky by the Kentucky Chamber of Commerce, based on surveys of our employees

Are you passionate about serving in an environment of shared purpose and shared goals while driving the ARC mission and values to excellence for our clients, patients and team members?  ARC has been leading the way and has become one of the fastest growing healthcare systems in Kentucky (and beyond) in addiction treatment, mental health services and improving lives by creating opportunities for people to discover hope and live their God-given destiny

ARC is ready to offer you “The B.E.S.T. of ARC” (Balance, Energy, Safety, Training) on day 1 when you enter through our doors.  ARC is a thriving, dynamic, and fast-paced healthcare system environment where compassion, accountability, respect for the dignity of life, entrepreneurship,  and stewardship are key elements of everything we do

We are hiring a Compliance Auditor II for our growing team The Compliance Auditor II works under the direction of the Vice President of Compliance and performs audits primarily of financial matters relative to billing and coding accuracy.  The Compliance Auditor II assess the accuracy of the company’s claims records and that controls in place are sufficient to to protect against fraud, abuse, and excessive waste of resources.  Additionally, the Compliance Auditor II completes other non-billing audit protocols as assigned to assess the compliance of other identified compliance risk areas. The Compliance Auditor II is responsible for maintaining a working knowledge of all applicable rules and regulations and to stay abreast of any changes over time.  

Key Responsibilities:

  • Compiles, analyzes, and verifies medical records, and other pertinent data sources to conduct comprehensive audits of client’s medical records in an assigned facility per audit policies and procedures to determine standards of care compliance and medical necessity.
  • Verifies the accuracy of the facility's records to safeguard against mismanagement, fraud, and abuse.
  • Observe the delivery of clinical services, either in person or remotely, to assess how well the facility’s operations comply with the ARC policies and procedures, laws, government regulations and appropriate accreditation standards.
  • Prepares and communicates audit results, conclusions and recommendations to the VP of Compliance, administration, managers, and facility staff as directed in a timely fashion.
  • Assists in the development and implementation of audit recommendations and any additional follow-up actions, including adjustments and rebilling of accounts.
  • Conducts chart audits and follows up on departmental action plans as a result of chart audit errors to ensure appropriate action has been taken and issues resolved. 
  • Audits patient accounts for accuracy of information, patient demographics, insurance information, etc., and for completeness.
  • Assures accurate ICD-9/ICD-10 and CPT coding on patient accounts.
  • Identifies and reports discrepancies in a timely manner.
  • Submits conclusions and recommendations to the appropriate level of management as directed by the VP of Compliance.
  • Maintains working knowledge of current Medicaid requirements and stays abreast of regulatory guidance issued by the Centers for Medicare and Medicaid Services (CMS). 
  • Knowledgeable of the facility's EMR and billing systems.
  • Assesses the degree in which documented notes comply with current standards and policies.
  • Performs follow-up audits to ascertain that appropriate corrective actions were implemented.
  • Maintains a collaborative working relationship within the department and with other departments.
  • Demonstrates the ability to be flexible, organized and function under stressful conditions.
  • Follows policies and procedures, performance improvement objectives, quality assurance initiatives, and safety and environmental standards.
  • Keeps current in field through continuing education, professional publications, and journals.
  • Communicates the mission, ethical business practices, and goals of the facility, as well as the focus of the Compliance department.
  • Attends trainings, conferences, and seminars and stays abreast of all applicable compliance topics and regulatory issues applicable to the company’s activities.
  • Maintains patient confidentiality at all times.
  • Supports and maintains a culture of safety and quality.
  • Performs additional duties as assigned.

Key Experience and Education Needed:

  • Auditing and/or coding experience required. 
  • Experience in healthcare and/or behavioral health setting required.
  • Excellent communication skills, both verbal and written, and the ability to share complex concepts with a mixed audience in a productive manner.
  • Post-secondary degree with proven work experience in his/her field
  • Experience in a behavioral health inpatient/outpatient environment preferred
  • Ongoing education in behavioral health preferred 
  • Proficient in information technology and 
  • Working knowledge of HIPAA compliance 

ARC full-time employees enjoy very attractive benefits packages for employees and their families to include health, dental, vision, life insurance, a wide array of ancillary insurance products for life’s needs, 401(k) plan with company matching and to ensure the work-life balance - generous paid vacation, sick, holiday and maternity/paternity leave policies.

Come join ARC and transform lives anchored in strong family relationships, social responsibility and meaningful career paths by empowering our nationally recognized crisis to career model

 

Addiction Recovery Care, LLC and its affiliated entities are an equal opportunity employer.

ADA Disclaimer: In developing this job description care was taken to include all competencies needed to successfully perform in this position. However, for Americans with Disabilities Act (ADA) purposes, the essential functions of the job may or may not have been described for purposes of ADA reasonable accommodation. All reasonable accommodation requests will be reviewed and evaluated on a case-by-case basis.

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