COMPLIANCE AUDITOR SR

Position Summary

Performs complex level professional internal auditing. Work involves leading or conducting compliance audit projects for Covenant Health entities as they relate to charging, coding, documentation and billing compliance. Also provides consulting services to the organization’s management and staff and coordinates requested investigations and educations. Maintains all organizational and professional ethical standards. Works with Covenant leaders and coworkers to coach, mentor, and train department staff. Works independently under limited supervision with significant latitude for initiative and independent judgment. Reports to the Compliance Audit Manager.

Risk Areas and Auditing Procedures

Identifies and evaluates company risk areas and provides auditing procedures related to documentation, coding and billing including reviewing and analyzing findings. Reviews and studies all information published by the federal government, fraud alerts, legal advisory opinions, and other publications related to coding, billing and reimbursement compliance, staying abreast of current regulations.

Audit Projects and Reporting

• Reviews and analyzes findings from audits and prepares written reports for physicians, clinical management, and related compliance committees.
• Communicates or assists in communicating the results of audit projects via written reports to physicians, clinical management and presents (as needed) to related compliance committees.
• Documents all audit activities in a designated location; reports statistics and identified problems as directed by the Audit Workflow Process and Policy.

Special Projects and Teamwork

• Coordinates with appropriate parties to complete over or under payments of claim errors identified during audits in accordance with Audit Policy.
• Assists with special projects as requested by leadership.
• Works in conjunction with health information management, patient accounting, information systems and other personnel to assist with implementation of solutions to mitigate risk.

Leadership and Training

• Reviews and evaluates ongoing activities involved in the baseline and periodic compliance audits and compliance programs as deemed appropriate by manager.
• Provides leadership to the audit team and assists with training of coworkers to include new employee orientation, systems overview and production of written deliverables.
• Advises, educates and acts as clinical/billing liaison between system-wide facility leaders, department managers and billing staff as designated by manager in relation to audit findings and process improvement initiatives.

Communication and Customer Service

• Maintains lines of communication with Facilities/Clinics in an ongoing effort to improve the overall quality of customer service.

Education and Certifications

Minimum Education: Must be sufficient to meet the standards for achievement of the below indicated license and/or certification as required by the issuing authority. Minimum Experience: Five (5) years’ experience in health care. Good working knowledge of healthcare billing, Medicare/Medicaid billing guidelines, and other Third Party Payor rules and Regulations. Experience in problem solving and analytical reviews. Must be knowledgeable in use of PC’s, Windows, Excel and Word Processing. Must have good public relations skills.

Licensure Requirement

Licensure Requirement: Must have certification (RHIT, RHIA, CCS or CPC) in field of healthcare related study or current clinical license/registration in the State of Tennessee as RN with equivalent coding experience.