Auditor - Data Analyst (45079)

Under general supervision of the Compliance Officer / Risk Manager, the Auditor/Data Analyst supports an effective compliance and quality management program by coordinating audit processes that includes reviewing, analyzing data, and preparing clear and accurate reports. This position assists in ensuring regulatory adherence, improving processes, and strengthening organizational integrity.  Upholds the principles of WIHCC’s, Mission, Vision and Values Statement. Maintains confidentiality of all privileged information at all times.

This list of duties and responsibilities is illustrative only of the tasks performed by this position and is not all-inclusive.

Essential Duties & Responsibilities:

• Maintains regular attendance and punctuality.
• Maintains a current understanding of regulatory trends and changes in coding guidelines and reimbursement policies that affect WIHCC and its subsidiaries by monitoring various resources to assess regulatory changes and determine organizational impact.
• Assists in the development and updating of appropriate policies.
• Monitors billing and coding trends to ensure compliance and accuracy while supporting revenue optimization.
• Monitors AHCCCS updates affecting 638 facilities related to billing requirements and standards.
• Provides quarterly audit and compliance activity Reports to the Compliance Committee.
• Conducts annual facility-wide risk assessment and documents results.
• Identifies, analyzes, and interprets trends within complex data sets; prepares summaries, graphs, and presentations explaining key findings.
• Supports quality initiatives including PQRS, Meaningful Use, and similar programs. 
• Conducts basic analysis for audits, projects and reports.
• Conducts basic statistical analyses for audits, projects and reports.
• Assists in developing coding educational plans, training materials, and resources related to the compliance program.
• Conducts compliance audits and ensures the audit project log/ system is current and accurate.
• Interacts professionally with all levels of management, while maintaining objectively and independent.
• Converts data into statistical information i.e., charts, graph, spreadsheets, run charts, etc. 
• Shares information with appropriate Department or Committee.
• Handles confidential information with maturity and discretion and in compliance with all laws and regulations.
• Upholds all principles of confidentiality and patient care to the fullest extent.
• Adheres to all professional and ethical behavior standards of the healthcare industry.
• Adheres to WIHCCs Personnel Policies and Procedures, departmental policies, rules, and regulations.
• Interacts in an honest, trustworthy and dependable manner with patients, employees, visitors, and vendors.
• Possesses cultural awareness and sensitivity.
• Maintains compliance with all Human Resources requirements.
• Provides support to the Compliance/Risk Management Department as needed and required.
• Performs other duties as assigned.

Minimum Qualifications: 

Bachelor’s degree in Business Administration, Statistics or any healthcare field.  Minimum of one year working experience with data or performance improvement, compliance, or related functions. Experience with the Revenue Cycle processes preferred.  Bilingual skills in English and Navajo language preferred.  Must maintain a valid unrestricted and insurable driver’s license.  Must successfully pass a background investigation and maintain suitable requirements for a Child Care position. This position is considered as a Child Care position, which requires a satisfactory background check investigation and is subject to the requirements of the Indian Child Protection and Family Violence Prevention Act, as amended (henceforth referred as the ICPFVP Act).

Knowledge, Skills, Ability:

• Knowledge of statistics, data mining, and electronic health records.
• Knowledge of applicable federal, state, county and local laws, regulations, and requirements.
• Knowledge and familiarity with Performance Improvement data analysis, data reporting, development and automated production of reports.  
• Skill in analyzing problems, projecting consequences, identifying solutions, and implementing recommendations.
• Ability to monitor important aspects of care by individual practitioners as well as practitioners in the aggregate to establish internal benchmarks and compare to external benchmarks.
• Knowledge of strong work ethics in the workplace.
• Knowledge of basic application of confidentiality.
• Knowledge of duties and responsibilities of the position.
• Knowledge of basic computer skills, e.g. Outlook, Word, Excel, PowerPoint, Publisher.
• Knowledge of grammar, spelling, punctuation and appropriate formatting.
• Ability to work under the pressure of dealing with multiple tasks/projects and constant deadlines, while maintaining attention to detail and accuracy.
• Ability to handle and resolve issues using advanced conflict management skills.
• Ability to be dependable in attendance and job performance.
• Ability to meet attendance, overtime (if necessary), and other reliability requirements of the job.
• Ability to accept and learn from feedback.
• Ability to communicate effectively both verbally and in writing.
• Ability to provide exemplary customer service at all times.
• Ability to interact positively with others and possess great interpersonal skills.
• Ability to multitask and perform well under pressure.
• Ability to have self-confidence.
• Ability to be a great team player.
• Ability to accept and learn from supervisor/peer critique.
• Ability to be flexible and adaptable to the changing needs of the organization.

Physical Demands:

While performing the essential functions of this position, the employee is regularly required to walk, sit, use hands and fingers, handle, or feel objects and equipment, reach with hands and arms, and communicate effectively by talking and hearing. The employee frequently must stand, climb, balance, stoop, kneel, crouch, or crawl and may occasionally use taste or smell. The employee must occasionally lift and/or move objects weighing up to 50 pounds.

Work Environment:

Work is performed in an office setting or outdoor work environment with moderate noise levels. Work environment may involve exposure to physical risks, such as blood borne pathogens, hazardous chemicals, or operating potential dangerous equipment, and requires adherence to all safety protocols. Required work schedules may include evening, weekend, overnight shifts, extended hours, or irregular schedules as operational needs dictate.  

As required by P.L. 93-638, absolute preference will be given to qualified Navajo applicants.  If there is no qualified Navajo applicant, preference will be given to qualified American Indian applicants.