Job Description

Employment Status:
Full time
Job Function:
Management and Executive
Department:
406001 Compliance-Mgmt
Shift Hours / Days:
Hours / Pay Period:

JOB OVERVIEW:

The Director of Compliance Audit Coding will work closely with the Physicians, site Senior Advisors for Compliance, Revenue Cycle Management, Medical Records, Information Services, and Financial Departments to proactively develop and monitor internal controls to manage, detect, and mitigate billing, coding and documentation issues that present potential compliance risks. The Director will work closely with other departments including clinical and support staff to resolve identified issues and implement corrective action plans.

RESPONSIBILITIES:

  • The Director will implement a comprehensive hospital and professional billing program including writing policies and procedures and overseeing risk assessments, investigations, audits, and corrective action plans in relation to the program.
  • Develop, implement, execute and monitor CTCA’s Annual Audit workplan, incorporating key concerns from the OIG workplan, priorities from the CTCA Board, items identified internally through the CTCA billing department as issues and concerns, past governmental and payor billing and audit issues, as appropriate.  The annual Audit Plan may also include fraud and abuse, HIPAA, and other regulatory and compliance items to be audited.
  • Direct all external hospital audit activity including ensuring timely response and process improvements are completed.
  • Work with Chief Compliance Counsel in pre-audit strategic planning and developing an audit plan for presentation to the Management Compliance and Risk Committee.
  • Develop and manage the budget for the compliance coding and audit team.
  • Provide enterprise-wide education to physicians, revenue cycle team members, facility coders, physician coders, and billing staff on a regular basis.
  • Reports compliance concerns to Chief Compliance Counsel as appropriate.
  • Supervises team of auditors engaged in conducting enterprise coding audits and education to ensure facility and physician coding and billing compliance with legal and regulatory requirements.
  • Identifies departments or providers that do not meet established coding and documentation compliance targets.  Determines appropriate action plans, education and follow up. Coordinates the department/provider re-audit process, as necessary.  Monitors coding and documentation improvement activities. 
  • Compiles and reports quarterly compliance/audit activities for Finance and Risk Committee and Management Compliance and Risk Committee of the Board. 
  • Identifies inefficient audit processes by analyzing workflows and suggests modifications to policies and procedures as appropriate.

EXPERIENCE:

  • 8 years of related management experience, project management, and compliance program implementation.
  • Experience with compliance auditing, facility and/or physician coding and billing, PPS systems of payment (e.g. DRG, APC, APL, HHRG, CMG) and Medicare provider-based rules preferred.
  • Knowledge of ICD-10, CPT, and HCPCS coding systems
  • Minimum 8-10 years of experience in a healthcare compliance, coding or billing, finance, and auditing environment.
  • 2-4 years progressive supervisory experience, leading, supervising, or managing a team.
  • 2-4 years of experience reviewing and auditing medical records
  • Knowledge of CMS (Medicare and Medicaid) and commercial payers' billing and documentation guidelines required.

KNOWLEDGE AND SKILLS:

  • The ideal candidate is organized, independent, ethical and motivated.
  • Knowledge of hospital operations, reimbursement and legal/regulatory requirements
  • Ability to present findings and discuss issues with providers confidently and effectively
  • Strong attention to detail and highly organized
  • Strong interpersonal, analytical and presentation skills
  • Strong written and oral communication skills
  • Strong team player with ability to work well independently and as a group
  • Ability to work under pressure, multi-task and meet deadlines
  • Technical capacity to utilize multiple information systems and Microsoft applications

EDUCATION:

Bachelors’ Degree in Health Information Management or related field is required.  MHA, MBA and/or related degree desired

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

  • Certified Coder required (AAPC, CCS, CPC or RHIA)
  • Compliance certification desired (CHC)

 

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