Compliance Audit Coordinator -Full-time with Benefits

Job Details

Description

Job Summary

Supports the Corporate Compliance Specialist, coordinates and conducts internal compliance audits to help ensure compliance with applicable statutory and regulatory requirements and organizational policies and procedures. Identify and resolve operational issues with improvement in the work process. Tracks and trends external audits related to Recovery Audit Contractor (RAC), Certified Error Rate Testing (CERT), Target Probe and Education (TPE), Fraud Waste Abuse (FWA) and other audit request.

The Compliance Audit Coordinator position provides guidance, support, and oversight to the organization ensuring effective management of the audit response process for all payers; coordinates with subject matter experts to manage the appeals of the adverse audit determinations as well as the clinical responses provided by Frederick Health; evaluates data associated with audit activities, tracks and measures the effectiveness to responses received. The Compliance Audit Coordinator will assist the Corporate Compliance Specialist to manage, monitor ,support, and report on the consistency and adequacy of the system’s response to the audit recovery requests.

Supports the Mission of Frederick Health Hospital and complies with the hospital’s Standards of Behavior.

Required Knowledge, Skills And Abilities

• Identifies improper Medicare overpayments and underpayments.
• Investigates those accounts received under the RAC program and determines if they are appealable, ensuring that these duties are performed in a timely manner; makes sure accounts are tracked and followed up on, updating spreadsheets on a regular basis to ensure proper tracking and follow-up.
• Coordinates audit projects and develops audit plans and procedures specific to each project.
• Researches, analyzes, and interprets rules and regulations applicable to the audit project.
• Communicates audit findings through written reports and/or meetings with management and staff, as applicable.
• Work proactively with hospital staff and physicians to ensure areas impacted by audits and corrective action plans when deficiencies are identified.
• Performs follow-up inquiries to assess whether recommended changes were implemented.
• Maintains tables or data in Microsoft Excel or Access Database.
• Requires understanding of many complex and varying guides, systems, regulations, and tools; utilizes critical thinking skills to manage an ever-evolving process that includes financial, clinical, and medical/legal components
• Stays current on trends related to medical necessity, annual code changes, billing and documentation requirements including local coverage determinations (LCD), medlearn matters (MLM).
• Maintains CEU requirements by attending conferences, seminars, and audio conferences.
• Adheres to all patient confidentiality policies and carries out all tasks in a pleasant and respectful manner
• Makes suggestions for enhancements throughout the department and continually seeks opportunities to improve current policies, procedures, and practices
• Demonstrates responsibility for professional growth and development; organizes workload and prioritizes tasks effectively
• Assists the Corporate Compliance Specialist with special projects and other job related duties.
  
  

Minimum Education, Training, And Experience Required

Education

• Bachelor's degree and/or revenue cycle or patient accounting experience required.
• CPC, CCS Coding Credential Preferred. AHIMA, American Academy of Professional Coders.
  
  

Experience

• Exposure to clinical, ancillary/clinical, and finance/business operations required
  
  

Knowledge, Skills, Abilities

• Knowledge of rules and regulations pertaining to hospital reimbursement-must have a patient accounting background with fundamental knowledge of revenue cycle processes, which includes patient access, case management/utilization review, charge capture, HIM, patient accounting.
• Strong attention to detail.
• Analytical, written, and computer skills
• Knowledge and application of spreadsheet, Word processing, and presentation software
• Excellent oral and written communication skills.
• Strong organizational skills and ability to prioritize and manage multiple tasks;
  
  

Ability to maintain a high level of confidentiality.

Caring for you as you care for the CommUNITY

Frederick Health offers a comprehensive and affordable benefits package. Health, Dental and Vision insurance are offered the 1st of the month after 30 days of employment to all employees hired to work at least 20 hours per week and offer multiple plans to best meet you and your family needs. Life insurance, Short-Term Income Replacement and Long-Term Disability are employer paid for eligible employees. Frederick Health offers a robust Paid Time Off program for eligible employees. Our 403B retirement plan helps you save for your retirement and includes an employer match to eligible employees. All employees have access to free financial planning sessions. We also offer an educational assistance program to support your education goals as well as an employer paid Employee Assistance Program.

Salary Range - $58,260 - $85,737

Business Hours, Monday-Friday