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Enterprise Provider Compliance Auditor/Educator

3 months ago

Ludlow Falls, United States WVU Full time

Enterprise Provider Compliance Auditor/Educator - Hybrid Welcome We’re excited you’re considering an opportunity with us To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position. The Enterprise Compliance Auditor/Educator will assist with the implementation and facilitation of ongoing compliance auditing, monitoring, and education associated with all provider services across WVUHS and its affiliates. The duties of this position will help ensure that all healthcare provider (MD/DO, APP, and other non-physician practitioners) organizations remain in compliance with all federal healthcare program rules, regulations, administrative requirements, and guidance. MINIMUM QUALIFICATIONS : EDUCATION, CERTIFICATION, EXPERIENCE, AND/OR LICENSURE: High School Diploma or Equivalent AND Seven (7) Years of extensive experience in multi-specialty coding, E&M coding, procedural/surgical coding, as well as knowledge of governmental billing and coding regulations including the “Teaching Physician Guidelines” OR ; Associate’s Degree AND Five (5) years extensive experience in multi-specialty coding, E&M coding, procedural/surgical coding, as well as knowledge of governmental billing and coding regulations including the “Teaching Physician Guidelines”. Certified Professional Coder (CPC), Registered Health Information Technician (RHIT), OR Certified Coding Specialist- Physician (CCS-P). PREFERRED QUALIFICATIONS : EDUCATION, CERTIFICATION, AND/OR LICENSURE: Bachelor’s Degree. CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned. Conducts compliance-related audits and reviews. Coordinates with departments to conduct compliance audits and reviews. Coordinates with departments to conduct compliance audits. Evaluates the scope of the audit and develops/completes the required compilation of data analytical reports. Formulates and defines, along with the Director of Provider Compliance and VP of Corporate Compliance, the scope and objectives of audit or review. Researches regulatory requirements that pertain to the audit or review. Reviews medical record, billing, or other relevant documentation. Develops and writes audit reports which outline audit findings, recommendations, and corrective actions as needed. Leads and conducts meetings with respective departments or individuals to review audit reports and develop corrective action plans as necessary. Planning, developing, and conducting presentations for internal and external departments. Coordinates educational activities with the Director of Provider Compliance and VP of Corporate compliance to ensure organizational compliance education needs are met. Conducts and/or facilitates audit training/education activities of the Compliance Department. Reviews clinical issues with physicians to ensure appropriate physician documentation, coding, and reimbursement. Conducts and/or facilitates educational activities of the Compliance Department. Assists in planning of informational programs, education, and training sessions. Develops and conducts ongoing compliance, documentation guidelines, and billing education for new staff. Development of Policies/Procedures. Assists in review of new or revised regulations or policies issued by regulatory agencies. Conducts ongoing auditing, monitoring, and/or investigations related to compliance with policies and regulatory requirements. Assists in compilation of compliance statistics, findings, and status updates for reporting. Serves as compliance representative on assigned teams or committees. PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Extended periods of sitting. Extended periods of computer and telephone usage. May require large amounts of walking. May require ability to lift and/or carry heavy materials. WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Standard office environment. SKILLS AND ABILITIES: Knowledge of related provider healthcare compliance, revenue cycle operations, and auditing techniques required. Analytical and problem-solving skills. Effective verbal and written communication skills. Capability of working on assignments of varying difficulty and complexity. Proficient with personal computers and financial application software. Excellent organizational and time management skills. Excellent presentation skills. Ability to utilize electronic medical record and billing systems. Ability to analyze complex EMR workflows. Additional Job Description: This position will require 6 months of on-site training in Morgantown. Scheduled Weekly Hours: 40 Shift: Exempt/Non-Exempt: United States of America (Exempt) Company: SYSTEM West Virginia University Health System Cost Center: 508 SYSTEM Compliance Address: 3040 University Ave Morgantown West Virginia WVU Medicine is proud to be an Equal Opportunity employer. #J-18808-Ljbffr