Definition:

The Medicare Compliance Auditor reports to the Director of Clinical Education and, through auditing and monitoring activities, assists in ensuring compliance to state and federal laws, statutes, and regulations related to home health care services and billing processes within NHC HomeCare.

Qualifications:

• Valid, unencumbered multi-state RN or LPN license with at least 5 years clinical experience;
• Minimum five (5) years’ experience in Medicare-reimbursed home health care;
• Experience in auditing and analyzing clinical records;
• Deep working knowledge of the home health industry and of applicable state and federal laws, statutes and regulations, including reimbursement and compliance regulations;
• Demonstrated ability to engage, motivate, and train clinical and operations staff;
• Strong oral and written communication, interpersonal, and organizational skills;
• Strong analytical and critical thinking skills;
• Self-directed with ability to work effectively alone or as part of a collaborative team;
• Computer literacy to the extent required to competently perform job duties;
• Commitment to best practice patient care with optimum patient outcomes and satisfaction provided in compliance with regulations;
• Maintains current Driver’s License, car insurance, and safe driving record; and
• Able to meet Background Screening requirements.

Specific responsibilities:

• Serve as a subject matter expert with deep working knowledge of applicable laws, statutes and regulations;
• Serve as a knowledgeable resource regarding NHC policies and procedures;
• Perform detailed audits of documents, including medical records, to ensure compliance to government regulations. Related audits include but may not be limited to RCDs, ADRs, CERTs, RACs, ZPICs, TPE audits, and Reopening Process reviews;
• Compose professionally formatted letters submission to the government contractors;
• Submit records and appeals in a timely manner with accurate tracking and status reports;
• Prepare for and participate in Administrative Law Judge (ALJ) hearings;
• Initiate and track follow-up and resolution to investigations, document requests and audit findings with agency staff and Regional/corporate partners as needed;
• Maintain the confidentiality of protected health information and NHC business practices;
• Competently navigate the EMR system to access needed documents;
• Participate in conference calls, webinars, and on-site meetings/training as assigned or requested;
• Collaborate on developing and providing targeted teaching and training programs via appropriate instructional methods including instructor-led group trainings, on-line learning, videos/webinars, over-the-phone training, or workshops;
• Contribute to the development of written processes to ensure compliance.
• Perform other functions as required for position-related activities.

Contributes to the achievement of company goals, by

• Assuring efficient and effective management of related human and material resources;
• Maintaining a strong working knowledge of federal and state Home Health regulations, company policies and procedures, professional clinical standards and evidence-based best practices;
• Organizing, prioritizing, and completing projects independently in a timely and goal-oriented manner;
• Contributing meaningfully to the success of the NHC HomeCare team;
• Supporting and contributing to Quality Assessment Performance Improvement (QAPI) activities as indicated;
• Modeling the company’s ‘Better Way Promises’ and Standards of Code of Conduct and Compliance; and
• Representing and promoting NHC HomeCare positively in the community.