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Director, Auditing

2 months ago

Greenville, United States HealthPRO Heritage Full time

Overview:

This role integrates auditing with a comprehensive knowledge of denials management to evaluate current compliance programs and processes, and to assist with effecting change as necessary to maintain and improve regulatory compliance and reimbursement across service lines. This Director audits and provides recommendations to continually improve Company processes, programs and systems designed to address compliance issues related to surveys by payors, state, and federal programs, and to ensure Company staff is billing and documenting appropriately. This role oversees and collaborates on the development of compliance related data analytics, business intelligence, and other automated systems to support the organizations Corporate Compliance Plan.

Responsibilities:
  1. Evaluate effectiveness and efficiency of business processes and internal control systems as well as ensuring Company compliance with governance regulations.
  2. Conduct data analysis related to billing and clinical documentation to support the Corporate Compliance Plan.
  3. Help ensure that management, employees, and staff are in compliance with the rules and regulations of regulatory agencies and state licensure bodies, Company policies and procedures are followed, and that behavior in the organization meets established Standards of Conduct.
  4. Collaborate closely with clinical and billing teams to streamline denials/appeals processing and ensure timely submission of completed appeals.
  5. Identify, prevent, and detect regulatory and privacy compliance issues, consistent with the Companys Compliance Plan.
  6. Act independently in his or her position so as to protect against any conflicts of interest that may arise from performing assigned duties.
  7. Audit and monitor the effectiveness of Company policies, procedures and processes.
  8. Develop and oversee policies and programs that encourage all employees across the company to seek clarification of policies, discuss compliance questions and concerns, and report suspected fraud and other improprieties without fear of retaliation.
  9. Oversee ongoing activities related to adherence to policies and procedures on privacy of, and access to, patient health information and other protected information in compliance with federal and state laws.
  10. Conduct in-service education, training, and orientation classes for staff and ensure timely appointments of entity / agency administrators, and oversee quarterly and annual support structures for agency administrators, including virtual meetings and reporting.
  11. Audit revenue cycle processes and ADR/denials to promote compliance with regulatory reimbursement requirements and track denials/ ADR outcomes.


Recruiter : Email Address:
cmeckling@healthpropediatrics.com