Comp Audits & Inv Mgr - FT - Days - Corporate Compliance

DHR Health  -  US:TX:Edinburg - Days

Summary:

FLSA STATUS: ☒ Exempt ☐ Non-Exempt

MISSION STATEMENT:

Our Mission is to improve the well-being of those we serve with a commitment to excellence: every patient, every encounter, every time.

VISION:

Our Vision is to create a world-class health system to advance medicine and increase access for the communities we serve by empowering caregivers to heal through compassion, knowledge, innovation, integrated care and excellence.

POSITION SUMMARY:

Under the supervision of the Chief Compliance & Privacy Officer, the Compliance Audits and Investigation Manager provides high-level oversight and program coordination related to the implementation, evaluation, and maintenance of the internal coding audit program at DHR Health System and its Affiliates. 

POSITION EDUCATION/ QUALIFICATIONS:

RHIT, RHIA, CIC, CCS and/or CCSP. 

Certified Internal Auditor certification preferred.

Bachelor’s Degree (BS/BA) preferred 

Good written and verbal communication skills required 

Ability to read, write and speak English 

Ability to communicate clearly and concisely with all levels of management. 

JOB KNOWLEDGE/EXPERIENCE:

Knowledge in applicable laws, rules, best practices and requirements 

Ability to communicate effectively in both written and oral formats 

Risk Analysis and Management 

Internal audit industry perspective 

Adaptive to change ability to quickly and effectively adjust behavior or schedule 

Five (5) years coding experience in a multi-specialty health system 

Three (3) years coding auditing experience on a variety of specialties 

Experience in designing audit scope and methodology.

Organizational, analytical, writing and interpersonal skills 

Dependable and self-directed 

Critical thinking, problem solving and deductive reasoning skills 

Basic computer skills – familiarity with Windows based software programs 

Knowledge of regulatory environment and healthcare compliance requirements 

Responsibilities:

POSITION RESPONSIBILITIES:

Promote the facility's mission, vision, and values by effectively communicating and demonstrating them in daily operations. Considers mission, vision, and values in developing services, standards, and practices. 

Lead and conduct coding, billing, documentation, and compliance audits to verify the appropriateness, accuracy, and completeness of coding and charge capture activities while identifying potential compliance risks and opportunities for improvement. 

Develop and implement detailed audit and monitoring programs of varying complexity and scope to assess compliance with organizational policies, regulatory requirements, and industry standards. 

Conduct audits of medical records, billing and reimbursement activities, and operational processes to evaluate compliance with federal and state regulations, third-party payer requirements, and internal policies. 

Lead and manage compliance investigations, including allegations of regulatory noncompliance, HIPAA privacy concerns, documentation issues, billing concerns, and other compliance-related matters. 

Perform fact-finding activities, including document reviews, interviews, data analysis, and coordination with internal stakeholders to determine findings and recommend corrective actions. 

Oversee the intake, tracking, investigation, resolution, and documentation of compliance and privacy concerns to ensure timely and appropriate disposition. 

Participate in the administration and ongoing effectiveness of the Compliance and HIPAA Privacy Programs, including monitoring compliance with applicable laws, regulations, and organizational policies. 

Prepare comprehensive written reports summarizing audit and investigation findings, identifies root causes, and works collaboratively with leadership to implement corrective action plans and process improvements. 

Research applicable regulatory, documentation, coding, reimbursement, privacy, and compliance requirements and incorporate findings into audit plans, investigations, and monitoring activities. 

Coordinate audit planning, compliance reviews, investigations, and resolution of findings with the Chief Compliance & Privacy Officer and other organizational leaders. 

Review, develop, recommend, and implement policies, procedures, systems, and controls to strengthen compliance, privacy, and revenue integrity processes. 

Review documents and information relevant to compliance activities including, but not limited to, patient records, billing records, contracts, marketing materials, vendor arrangements, physician relationships, and other business records. 

Conduct compliance risk assessments and ongoing monitoring activities to identify emerging risks and evaluate the effectiveness of internal controls. 

Provide consultation, education, and guidance to physicians, leadership, and staff regarding documentation, coding, billing, HIPAA privacy, regulatory requirements, and compliance best practices. 

Facilitate one-on-one and group education sessions for physicians, providers, and employees regarding compliance, coding, billing, audit findings, and privacy-related requirements. 

Maintain a strong understanding of Medicare, Medicaid, commercial payer regulations, reimbursement methodologies, clinical coding requirements, documentation standards, HIPAA privacy regulations, and healthcare compliance program expectations. 

Build and maintain effective collaborative relationships with physicians, administrators, department leaders, and staff to support organizational compliance objectives and foster a culture of integrity and accountability. 

Assist with regulatory inquiries, audits, corrective action plans, and compliance reporting activities as requested. 

Other duties as assigned.

LINES OF REPSONSIBILITIES:

1. VP Chief Compliance Privacy Officer

Other information:

CUSTOMER SERVICE:

Provide excellent customer service to all DHR customers. All employees are required to attend the DHR C.A.R.E.S program which outlines the Customer Service Principals including: Commitment, Accountability, Respect, Excellence and Service.

AGE SPECIFIC:

Employees must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served in his/her assigned unit. The individual must demonstrate knowledge of principles of growth and development over the life span and possess the ability to assess data reflective of the patient’s status and interpret the appropriate information needed to identify each patient’s requirement relative to his or her age.

AMERICANS WITH DISABILITIES ACT: (ADA):

A. Essential Duties: Indicated by bold print within performance standards, preceding individual numbered criteria.

The following table provides physical requirements that will be associated with, but not limited to, this position:

B. Working Conditions: The individual spends over 95% of his/her time in an air-conditioned environment with varying exposures to noise. There is protection from weather conditions but not necessarily from temperature changes. The position does have low exposure to malodorous, infectious body fluids from patients and some minimal exposure to noxious smells from cleansing agents.

C. Occupational Exposure: This position has minimal to no exposure to blood, body fluids, or tissues and is an OSHA Category III (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Person who performs these duties are not called upon as part of their employment to perform or assist in emergency medical care or first aid or to be potentially exposed in some other way.

D. Aptitudes: HIGH 1 2 3 4 5 6 LOW

Intelligence: General learning ability: The ability to “catch on” or understand instructions and underlying principles. Ability to reason and make judgments.  3

Verbal: Ability to understand meanings of words and ideas associated with them, and to use them effectively. To comprehend language, to understand relationships between words, and to understand meanings of whole sentences and paragraphs. To present information or ideas clearly.  3

Numerical: Ability to perform arithmetic operations quickly and accurately. 2

Spatial: Ability to comprehend forms in space and understands relationships of plane and solid objects. Frequently described as the ability to “visualize” objects or two or three dimensions, or to think visually of geometric forms. 2

Form Perception: Ability to perceive pertinent details and objects or in pictorial or graphic material to make visual comparisons and discriminations and see slight differences in shapes and shadings of figures and widths and lengths of lines. 3

Clerical Perception: Ability to receive pertinent details and verbal or tabular material. To observe differences in copy, to proofread words and numbers, and to avoid perceptual errors in arithmetic computation.  2

Motor Coordination: Ability to coordinate eyes and hands to fingers rapidly and accurately in making precise movements with speed. Ability to make a movement response accurately and quickly. 3

Finger Dexterity: Ability to move hands easily and skillfully. To work with fingers in placing and turning motions. 3

Manual Dexterity: Ability to move hands easily and skillfully. To work with hands in placing and turning motions. 3

Eye-Hand-Foot Coordination: Ability to move the hand and foot coordinately with each other in accordance with visual stimuli. 3

Color Discrimination: Ability to perceive and respond to similarities or differences in colors, shapes, or other values of the same or different color. To identify a particular color, or to recognize harmonious or contrasting color combinations, or to match color adequately. 3