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 works under the direction of the Vice President of Compliance and performs audits primarily of operational and compliance risk areas not related to billing and coding of claims. The Compliance Auditor assists the VP of Compliance and other Compliance department staff in assessing the company’s operational practices for compliance with legal and regulatory expectations.  The Compliance Auditor 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 assigned facilities using predetermined audit protocols to assess the facility’s adherence to standard policies and procedures and regulatory expectations.
  • Works with the VP of Compliance to develop and perform audit protocols to assess the company’s performance relative to the 7 Elements of Healthcare Compliance: (1) Standards, Policies, and Procedures, (2) Compliance Program Administration, (3) Screening and Evaluation of Employees, Physicians, Vendors and other Agents, (4) Communication, Education, and Training on Compliance Issues, (5) Monitoring, Auditing, and Internal Reporting Systems, (6) Discipline for Non‐Compliance, and (7) Investigations and Remedial Measures
  • Reports audit findings to the VP of Compliance indicating exceptions to standard policies and procedures.
  • Assists in the preparation of important Compliance related documents, including but not limited to, the Compliance Risk Assessment, Compliance Work Plan, Compliance Training Plan.
  • Utilizes software to develop and maintain compliance workflows and track progress toward goals in a variety of Compliance related risk areas, including but not limited to, Privacy Statutes (HIPAA, 42 CFR Part 2, etc.), Documentation/medical necessity, Licensing/Credentialling, ethical service delivery, conflicts of interest, record retention, and marketing.
  • Collects compliance related data utilizing a variety of methods including but not limited to, conducting site visits, conducting surveys of clients and staff, interviewing clients and staff, review of clinical/medical documentation, and review of financial reports.
  • Prepares and communicates audit results, conclusions and recommendations to the VP of Compliance as directed in a timely fashion.
  • Performs chart audits as assigned to assess how clinical/medical documentation meets medical necessity requirements associated with contractual requirements.
  • Collaborates with others within the Compliance Department to investigate situations where medical necessity is not being met and further review is needed to ensure adherence with standard billing practices.
  • Follows up on departmental action plans as a result of audit findings to ensure appropriate action has been taken and issues resolved.
  • Maintains working knowledge of current Medicaid requirements and stays abreast of regulatory guidance issued by the Centers for Medicare and Medicaid Services (CMS).
  • Maintains working knowledge of the facility's EMR and billing systems.
  • 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:

  • Prior experience in healthcare, behavioral health, or human services settings.
  • Auditing and/or coding experience 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
  • Certification in Compliance, e.g., CHC or equivalent preferred
  • Experience in a behavioral health inpatient/outpatient environment preferred
  • Ongoing education in behavioral health or human services 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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