Associate Compliance Officer ACO Clinical Audit Quality an
Associate Compliance Officer ACO Clinical Audit Quality an
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Job Description
Description
Summary:
Associate Compliance Officer (ACO) Clinical Audit Quality and Revenue Cycle
Consistent with legal requirements and compliance program best practices this position is necessary for Nuvance Health to ensure integrity and compliance with: (i) Federal healthcare program requirements and internal policies and procedures as they relate to medical necessity and quality of care; (ii) Medicare and Medicaid conditions of participation; and (iii) applicable Federal and State clinical laboratory credentialing and employee health screening requirements. Reporting to the SACO the ACO is responsible in supporting and promoting clinical and revenue compliance throughout the Network.
Responsibilities:
audits on employee health and safety procedures and regulations according to OSHA standards;
audits on the environmental health safety program according to the requirements by Joint Commission;
moderately complex clinical audit activities and work assignments under the direction of the the SACO. Works independently with minimal supervision. Supports SACO with performing Clinical Audit Activities across Nuvance Health ensuring accurate quality processes and supporting SACO and Senior Compliance Officer (SCO) in evaluating adequacy and accuracy of clinical documentation;
targeted risk based audits per Compliance Department Work Plan and other audits identified by SACO and SCO across Nuvance Health;
accuracy of documentation orders medical record completeness billing charging quantity revenue codes etc. Reinforces proper documentation and billing consistent with Nuvance Health Policies State and Federal Regulatory and Reimbursement Guidelines maintaining and supporting Compliance throughout the Network;
payer audits applying appropriate Medicare Medicaid guidelines. Conducts post audit exit conference and arranges for payments due from or to Nuvance Health and closes out the audit. Effectively communicates audit results to SACO and SCO;
on issues noted areas of potential risk and post audit corrective action completion under the direction of the SACO or SCO. Assists in identifying opportunities for process improvement and education in of regulatory requirements; assists in developing and conducting appropriate education;
SACO and SCO in performance and completion of the department Work Plan. Assists with ensuring timely and ongoing accuracy of department spreadsheets and database of clinical audit activities; assists in retrieving data and preparing quarterly reports of audit findings and activities for the SACO SCO in preparation for ERCC and Audit Committee meetings;
support to SACO SCO for government audits such as OIG RAC MAC CERT ZPIC and other supplemental contractors. When notified of external regulatory requests for medical records ensures medical records and supporting materials are complete and submitted in a timely manner. Perform preaudit work and communicates audit requests to SACO and SCO;
moderately complex compliance audits followups with corrective action plans; serves as a resource for documentation criteria for regulatory billing requirements including for new programs or services being implemented by Nuvance Health;
support to Revenue Cycle as needed to audit accounts for Patient Requested and Revenue Cycle requested audits.
and effectively communicates with external and regulatory auditors; Nuvance Health physicians nurses and other clinical practitioners Managed Care Revenuee Cycle Information Technology Group Finance Coding and Documentation and Denial Management;
the SACO and SCO with the development of updating maintaining/disseminating training manuals and education material to Clinical Audit Staff Operational and Service Departments and Clinicians as directed by SACO or in the development of Clinical Audit Policies and Procedures and recommends process improvement solutions;
principals of independence and Code of Conduct policies in performance of medical audit confidentiality of all information to include financial operational patient registration and clinical information;
and Model Nuvance Health Values;
regular reliable and predictable attendance;
other duties as required.
Education and Experience Requirements:
An Associates degree with 5 years of experience or a Bachelor Degree with at least four 3 years of jobrelated experience;
An Associates or Bachelors in nursing or other allied health field (e.g. respiratory therapist pharmacist physical therapist occupational therapist physician assistant).
Minimum Knowledge Skills and Abilities Requirements:
Microsoft Office Word MS Excel PowerPoint excellent verbal and written communication skills presentation skills a strong knowledge base in: of clinical audit clinical record documentation Medicare Conditions of Participation; and
Previous working experience as Environmental Health Safety and/or Environmental Policy.
License Registration or Certification Requirements:
The successful candidate shall hold the following certifications and/or licenses:
- Registered as a Nurse or licensed as another clinical or allied health provider in the State of New York or Connecticut.
Working Conditions:
Manual: Some manual skills/motor coord & finger dexterity
Occupational: Little or no potential for occupational risk
Physical Effort: Sedentary/light effort. May exert up to 10 lbs. force
Physical Environment: Generally pleasant working conditions
Company: Nuvance Health
Org Unit: 1771
Department: Corporate Compliance
Exempt: Yes
Salary Range: $33.66 $67.05 Hourly
Required Experience:
IC
Employment Type
Full Time
