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Compliance Auditor

2 months ago

Nashville, United States Surgery Partners Full time
Description

JOB TITLE: Compliance Auditor - Remote Opportunity

Audit / Investigation

  • Coordinate, assist, or conduct compliance audits, and investigations as required, which may include audits designed to review the adequacy of medical record documentation to support claims, as well as inquiries into suspected or reported deviation from compliance program requirements.
  • Develop and implement audit tools that align with CMS audit protocols and regulatory guidance.
  • Assists facilities with audit and re-bill projects related to potential governmental payment issues.
  • Monitor corrective action plans and risk areas to schedule ad hoc validation reviews.
  • Participate in compliance and alleged fraud investigations.

Reporting

  • Develop reports of findings, status, risk issues and recommendations for remediation. Present audit reports and findings to management and committees as needed.
  • Review and validate responses to audit reports to ensure remediation was satisfactory.
  • Assist with reporting to governmental agencies in accordance with company policies and procedures.

Compliance Education

  • Provide consultation and education for Surgery Partners staff impacted by compliance activities.
  • Assist in the development and provision of compliance training to employees, medical staff, and independent consultants. Compile training reports to monitor adherence to training requirements.
  • Performs research and analysis on Corporate and federal payer rules, regulations and transmittals and communicates requirements to operational areas.

Issue Tracking

  • Participates in Compliance Operations Meetings and assists with the tracking and resolution of compliance issues that affect operations.
  • Maintain logs of inquiries and track research and disposition of compliance issues raised by senior
    management, employees, business partners and external auditors.

Collaboration / Leadership

  • Adhere to all company policies and procedures. Practices and adheres to the "Code of Conduct" philosophy and "Mission and Value Statement".
  • Provide support to joint projects with other Compliance audit staff.
  • Collaborates with operational department managers to resolve compliance or regulatory concerns.
  • Communicate regularly with internal departments to ensure audit deliverables and remediation responses are submitted timely.
  • Acts as a resource for compliance, coding, charge capture and third-party reimbursement regulations and rules.
  • Provides advisory assistance regarding billing compliance matters.
  • Formulate, affect, interpret, and implement compliance policies and procedures as needed.

Other

  • Assist the Chief Compliance Officer in risk analysis, planning, auditing and program development for
    compliance activities throughout Surgery Partners
  • Formulate, affect, interpret, and implement compliance policies and procedures as needed.
  • Analyze compliance and internal process risks for all Surgery Partners Operational areas.
  • Travel may be required periodically with this position but is not expected to exceed 25% of time now
    or in the immediate future.
  • Other duties as assigned.

Basic Surgery Partners Performance Criteria

  • Demonstrates Surgery Partners and Code of Conduct as well as adheres to policies and procedures and safety guidelines.
  • Demonstrates ability to meet business needs of department with regular, reliable attendance.
  • Employee maintains current licenses and/or certifications required for the position.
  • Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.
  • Completes all annual education and competency requirements within the calendar year.
  • Is knowledgeable of compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.

EDUCATION/EXPERIENCE:

  • Bachelor's Degree in Business Administration, Health Information Management, Health Administration or similar degree. Equivalent work experience may substitute education requirements.
  • Minimum 2-4 years previous healthcare experience, preferably with demonstrated skill in compliance auditing.
  • Prefer candidate with at least two years' experience in one or more of the following areas: Accounting/Auditing, Medical Coding, Risk Planning/Compliance, or Healthcare Billing.
  • Valid driver's license when driving any vehicle for work-related reasons.
  • Certification as CHC, CPC, RHIT, RHIA, or CCS-P or willingness to become certified preferred but not required.