Manager, Compliance Audit & Analysis
Manager, Compliance Audit & Analysis
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1 Vacancy
Job Description
Overview
Be inspired. Be rewarded. Belong. At Emory Healthcare.
At Emory Healthcare we fuel your professional journey with better benefits valuable resources ongoing mentorship and leadership programs for all types of jobs and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide:
Comprehensive health benefits that start day 1
Student Loan Repayment Assistance & Reimbursement Programs
Familyfocused benefits
Wellness incentives
Ongoing mentorship development and leadership programs
And more
Work Location: Atlanta GA
Description
- Reporting to the Director Compliance Audit and Analysis oversees audits monitoring and education for hospital and professional billing coding and documentation programs that confirm compliance identify reimbursement implications and provides billing providers with relevant and timely information regarding audit results and risk areas.
- Evaluates hospital and professional billing compliance activities to assess compliance and appropriate focus on risk areas.
- Implements policies strategies and workflows to ensure accurate medical record documentation professional billing and coding compliance.
- Serves as a resource for the organization regarding coding and billing compliance including conducting research as needed to help the organization achieve compliance.
Principal duties and responsibilities:
- Formulates reviews and updates EHC compliance policies related to billing and coding.
- Communicates applicable policies and procedures to the enterprise as needed.
- Prepares and oversees billing and coding components of the Compliance work plan reflecting scheduled activities and target dates.
- Leads focused audits and reviews to investigate adherence with billing compliance policies legal and regulatory requirements and to identify and evaluate risk areas.
- Assists in development of organizational compliance auditing and monitoring activities for billing and coding including periodic reviews of the individual department auditing and monitoring functions.
- Coordinates sample reviews to ensure codes that were billed are properly supported by appropriate documentation.
- Creates audit result reports to be reviewed with departments and providers as applicable.
- Leads education sessions with departments coders and/or providers as applicable to review audit results.
- Conducts sample and focused reviews to ensure coding and billing is compliant with government and payor guidelines.
- Analyzes and reviews medical record documentation and billing data for all pertinent internal and external audits in collaboration with Revenue Cycle as appropriate.
- Works collaboratively with clinical and administrative departments throughout the organization to further the organizations objectives and serve as an advisor regarding coding and billing compliance risks.
- Supports compliance education initiatives including overseeing the development and delivery of coding and billing compliance educational programs to address existing and emerging Federal and State requirements
- Manages and fosters relationships with internal clinicians and coders and thirdparty clinical reviewers.
- Assists with provision of counseling education and/or recommendations for disciplinary action if necessary or required for noncompliance with any internal or external policies and procedures related to billing compliance.
- Implements and maintains a system of management reporting that provides timely and relevant information on all aspects of billing auditing and monitoring and related compliance issues.
- When appropriate manages staff who may be conducting focused coding and billing compliance audits and/or other special projects included in the annual departmental work plan.
- Maintains required credentials participates in continuing education opportunities to remain current with billing and coding compliance best practices (i.e. conferences workshops and other professional development activities).
- Actively participates in system wide management activities attends meetings and inservice/educational programs and other activities as requested.
Education and experience requirements:
- Bachelors degree required.
- Clinical background preferred (i.e. LPN RN etc.).
- Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) credentials required.
- Certification in Health Care Compliance preferred.
- Minimum of five (5) years of experience with audit activities required.
- Minimum of three (3) years of experience in hospital/clinical coding and billing management including ICD10 and CPT coding HCPCS experience in a multispecialty professional and hospital/clinical billing environment required.
- Proficient in MDAudit Enterprise software and Epic electronic health record systems.
- Thorough knowledge of coding documentation improvement practices.
- Thorough knowledge and understanding of billing coding and documentation requirements Federal and State regulations unbundling edits medical necessity clinical best practices and professional billing issues.
- Project management experience preferred.
Knowledge skills and ability requirements:
- Knowledge of legal regulatory and policy compliance issues related to coding billing procedures and documentation.
- Ability to clearly communicate coding information including the results of coding compliance audit activities.
- Proficiency in root cause analysis critical thinking and gaining acceptance of recommended solutions.
- Team player and understands role in relationship to others.
- Strong interpersonal and communication skills.
- Clear concise and persuasive writing and presentation skills.
- Strong orientation to deadline and detail.
- Strong organizational and project management skills.
- Working knowledge of computer software Word Access Excel PowerPoint; as well as Epic EMR.
- Working knowledge of claims data and analysis with experience working in the MD Audit tool preferred.
- Knowledge of healthcare financial management principles/practices.
- Ability to work in highly matrixed environments.
- Ability to be flexible and adapt to change
Additional Details
Emory is an equal opportunity employer and qualified applicants will receive consideration for employment without regard to race color religion sex national origin disability protected veteran status or other characteristics protected by state or federal law.
Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcares Human Resources at . Please note that one weeks advance notice is preferred.
Required Experience:
Manager
Employment Type
Full-Time
