Compliance Auditor will assist in the overall quality, compliance, and auditing activities to ensure compliance of standard operating procedures, corporate policies, industry standards, and applicable federal and state laws for CHRISTUS Health. Conducts audit activities and prepares reports summarizing audit results. Works in conjunction with Regional Director of Compliance and Privacy on compliance and privacy work plans, staff education, internal and external audits and reviews, and provides assurance that the organization is operating in an efficient and effective manner.
POSITION SPECIFIC COMPETENCIES
- Performs compliance and privacy audit and monitoring activities and coordinates with the CHRISTUS Regional team and the System Office as it relates to such audits.
- Collaborates with Regional Director of Compliance and Privacy on external audits and reviews, which are initiated by government agencies or government-contracted organizations.
- Coordinates medical record and claim reviews with the CHRISTUS clinical and revenue cycle departments.
- Performs monthly compliance and privacy audits according to the established work plan and calendar and prepares work plan summary slides with appropriate corrective action plans.
- Modifies work plan calendar through the year to include additional audits, based on audit results, risks, and corrective action plans.
- Serves as a member of the regional compliance committee and presents summary of compliance and privacy audit activities to the committee.
- Provides subject matter expertise to the facility staff as directed by the Regional Director Compliance and Privacy.
- Exercises due diligence in collaboration with Regional Director Compliance and Privacy to prevent and detect misconduct and wrongdoing. Undertake all reasonable steps to respond appropriately when an offense is detected and prevent future similar offenses.
- Ensure the enforcement of compliance program standards.
- Provides results of audits and education to HIM, Revenue Cycle Departments, physicians, hospital and clinic operations regarding privacy, charging, documentation, and billing requirements.
- Assists department with development of corrective action plans (CAP's), as needed, and ensure CAP's are implemented and successful by performing follow up audits.
- Communicates effectively with the regional compliance team, Corporate Compliance team in the system office, and hospital departments following the CHRISTUS Core Values.
- Assists Regional Director of Compliance and Privacy on OIG, OCR, and other government audits/reviews and other compliance-related work, as assigned.
- Maintains confidentiality and discretion regarding all work matters. Performs all duties in a manner that protects the confidentiality of patients and does not solicit or disclose any confidential information unless it is necessary in the performance of assigned job duties.
- Ensures compliance with all policies, procedures, and standards as promulgated by state and federal agencies, the hospital, and other regulatory entities.
- Performs other duties as assigned.
- Read, research, and understand the rules and regulations related to the audit, the scope of the audit, and the expected outcomes of the audit if all controls are in place and the audit goes as well as expected, prior to beginning the audit.
- Complete work plan activities as directed by the Regional Compliance Director and Corporate Compliance Team and submit compliance and privacy work plan summary slides by the 5th working day of each month.
- It is expected that Corrective Action Plans are implemented, tracked, and closed within 60 days.
- Effectively communicate results of the work plan reviews to the Regional Compliance Director, the Corporate Compliance team, hospital departments, and the hospital compliance committee.
- Bachelor degree is preferred, though extensive experience in healthcare revenue cycle, nursing, auditing, clinical operations, privacy or compliance will be considered
- Knowledge of and experience with Meditech, One Content, and EPIC preferred
Strong Skills with Microsoft products (Excel, Word, and Power Point)
- Five (5) years' experience or more in nursing, healthcare revenue cycle, privacy, or compliance
- Knowledge with healthcare compliance and integrity policies required
- Strong knowledge of DRG, CPT, CDM and billing and clinical operations required
- Overall knowledge of hospital department operations
- HCCA CHC and CHPC certifications preferred
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