Compliance Auditor - Inpatient Focus

Position Description

Primary focus on the compliance of home care, patient level of care, and patient status but also responsible for internal auditing of processes and practices to help assure consistency with federal and state law to include 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).

Communicate with external agencies regarding audits.

Responsible for auditing charge capture processes, coding and billing processes, and assisting in resolution of case or system failures.

Provide consultation in the application of process improvement principles as they relate to the results of any compliance audit functions and findings.

Knowledgeable in Medicare and Medicaid regulations and billing practices to appropriately guide and advise staff and processes.

Offer expertise to departmental personnel and medical staff in the areas of coding, billing, and compliance.

Effectively work with multi-disciplinary groups, skilled with interacting with physicians, nurses, and other healthcare professionals.

Research regulations/rules/laws to effectively analyze concerns and develop well-reasoned solutions based on official resources, recognize and validate assumptions, collect information, and draw meaningful inferences.

Maintain confidentiality and a sense of credibility and reliability.

Requirements

• Licensed Practical Nurse (LPN), Registered Nurse (RN), or bachelor’s prepared individual with significant healthcare and auditing experience.
• Clinical background is strongly preferred.
• A minimum of three to five years in a healthcare setting.
• Knowledge of Medicare/Medicaid laws.
• Superior interpersonal, analytical and computer skills, as well as the ability to work independently.
• Must have the appropriate background and knowledge needed to assess clinical documentation and medical record coding and to analyze data and identify trends and outliers.
• Excellent written and verbal communication skills that will support professional communication with all levels of management.
• Healthcare auditing experience preferred.
• Not a remote position.

Qualifications

Licking Memorial Health Systems is an equal opportunity employer and maintains compliance with all state, federal, and local regulations.

Licking Memorial Health Systems does not discriminate against applicants because of race, religion, color, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit based factors protected by law.