Compliance Audit Coordinator Full-time with Benefits

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 systems response to the audit recovery requests.

Supports the Mission of Frederick Health Hospital and complies with the hospitals 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

Bachelors 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.