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Regulatory Compliance Auditor
2 months ago
Corporate Compliance Overview
Licking Memorial Health Systems (LMHS) stands as a prominent, non-profit healthcare provider, committed to enhancing the health and wellness of our community. With a legacy that began in 1898, LMHS continues to be a pillar of healthcare excellence, addressing the dynamic needs of Licking County. Our state-of-the-art facility offers a wide array of patient care services, ranging from critical emergency medicine to the nurturing environment of home healthcare, alongside specialized medical services in areas such as oncology, cardiology, maternity, and mental health.
Joining the LMHS team means becoming an integral part of your local community hospital. Employment at LMHS transcends mere job duties; it is a unique chance to make a direct impact on the health and well-being of your friends, family, and neighbors. You will provide care in a familiar setting, where the influence of your work reaches beyond the hospital walls and into the heart of our community. Our dedication to diversity, equity, and inclusion guarantees that every community member receives service with dignity and compassion. Join us in our mission to prioritize patient safety, leverage advanced technology, and collaborate with a passionate team of highly skilled and compassionate professionals striving to enhance community health.
Position Overview
Under the general supervision of the VP of Financial Services, this role is responsible for comprehensive compliance auditing and monitoring within the Health Systems. This position plays a crucial role in ensuring the Health Systems' adherence to state and federal documentation and billing regulations.
Key Responsibilities
- Focus primarily on the compliance of the Health Resources and Services Administration (HRSA) 340B Drug Pricing Program while also conducting internal audits of processes and practices to ensure alignment with federal and state laws, including but not limited to compliance with the Centers for Medicare and Medicaid Services (CMS), Office of Inspector General (OIG), Ohio Department of Health (ODH), Ohio Department of Medicaid (ODM), and Recovery Audit Contractors (RAC).
- Engage with external agencies regarding audit processes.
- Oversee auditing of charge capture processes, coding, and billing practices, assisting in the resolution of any case or system discrepancies.
- Provide expert consultation on process improvement principles related to compliance audit outcomes and findings.
- Possess in-depth knowledge of Medicare and Medicaid regulations and billing practices to effectively guide and advise staff and processes.
- Offer expertise to departmental personnel and medical staff in coding, billing, and compliance matters.
- Collaborate effectively with multidisciplinary teams, demonstrating strong interaction skills with physicians, nurses, and other healthcare professionals.
- Research regulations, rules, and laws to thoroughly analyze concerns and develop well-reasoned solutions based on authoritative resources, recognizing and validating assumptions, gathering information, and drawing meaningful conclusions.
- Uphold confidentiality and maintain a sense of credibility and reliability.
- Certified Pharmacy Technician (CPhT), Licensed Practical Nurse (LPN), Registered Nurse (RN), or a bachelor's degree holder with substantial healthcare and auditing experience. A clinical background is highly preferred.
- A minimum of three to five years of experience in a healthcare environment.
