Plans and performs procedures to audit and monitor completeness, accuracy and timeliness of documentation, coding, billing, reimbursement, efficiency and effectiveness of operations and compliance with rules and regulations. Researches, analyzes and interprets laws and regulations and internal control theory to evaluate systems and processes supporting operational and compliance objectives. Performs complex professional and facility (DRG or APC) coding and billing audits across all clinical specialties.
Responsibilities:
Plans and performs auditing and monitoring projects at the request of Senior Management and the Audit and Compliance Committee of the Board of Trustees.
Participates in and documents risk assessments to develop and prioritize integrated audit programs; schedules, coordinates and supports the execution of operational, legal and system compliance audits in areas of responsibility.
Performs and documents risk assessments of organizational objectives during audits or other engagements and monitor risks on an ongoing basis. Communicates identified risks to senior auditors and CAS Management to ensure appropriate priority and mitigation opportunities are realized.
Designs and performs audit procedures including analytical review, internal control assessments, and substantive audit tests as required by the audit plans.
Participates and assists with development and implementation of the annual Risk Assessment and resulting audit plan.
Researches, analyzes and interprets reimbursement laws, regulations and other source materials in support of operational and compliance objectives.
Analyzes information and results of testing to develop conclusions relative to audit objectives.
Prepares documentation and audit reports for presentation to Operational leaders, Senior Management and the Audit and Compliance Committee of the Board of Trustees, including recommendations for improvements and evaluation of resulting management action plans.
Participates in the day-to-day activities of the Compliance office; reviews complaints, concerns, or questions regarding compliance issues, conducts investigation of complaints, and assists in the development of required action plans.
Assists or facilitates the development, management and continual improvement of compliance plans; participates in the development of individual department and section compliance plans, policies and procedures which define standards for compliance.
Conducts oversight reviews and audits to evaluate the extent of compliance with established plans, policies and procedures; recommends new administrative and operational improvements, as appropriate.
Organizes engagement work papers. Develops checklists, programs and work paper templates sufficient to support engagement objectives and satisfy professional standards for internal audit documentation.
Identifies opportunities for increased efficiency and effectiveness of processes used to meet departmental objectives. Tracks time and effort of individual work performed for use in evaluating overall performance of the individual and the department.
Performs other duties as required or assigned
Minimum Qualifications:
Bachelor’s degree in Business, Health Care Administration, Health Information Management with 3 years of experience or the equivalent in education and/or comparable competency in working with regulatory/clinical issues and/or professional or facility chart abstraction, CPT and ICD-9 coding and clinical documentation education required.
An understanding of health care operations, audit, compliance, and federal/state laws, coding and reimbursement guidelines required.
Knowledge of professional or facility chart abstraction, CPT and ICD-9 coding and clinical documentation highly desired.
Excellent analytical/critical thinking abilities and project management skills required.
Highly proficient with a variety of computer applications, including word processing and spreadsheet software required.
The ability to work independently with minimum supervision or within a team environment desired.
Strong interpersonal skills and excellent written, verbal and presentation skills desired.
The ability to interact with all levels of the organization including board, executive leadership, management, physicians and staff required.
