|Employer:||Duke University Health System
|Skills:||CPC,CCS,CIC,RHIA,RHIT,coding,clinical trials billing,auditing,billing
|Specialties:||Conduct health-system wide compliance audits, federal healthcare program requirements, clinical trials billing, privacy, conflict of interest, anti-kickback, physician relationships
|Required Experience:||5 to 7 years
|Preferred Experience:||5 to 7 years
* Coding certification (e.g. CPC, CCS, CIC, RHIA, RHIT) and coding experience is strongly preferred.
Conduct health-system wide compliance audits to ensure data integrity, compliance with federal and state regulations pertaining to but not limited to: federal healthcare program requirements, clinical trials billing, privacy, conflict of interest, and anti-kickback and physician relationships.
- Interpretation of applicable federal and state law and regulations to plan audit parameters, determine department's compliance with such regulations and communicate to department necessary changes in compliance with regulatory requirements.
- Responsible for conducting non-routine audits, documenting & communicating findings and recommendations, explaining regulatory requirements, and overseeing the corrective actions for audits within DUHS
- Conduct risk assessments and preparation of work plans.
- Develop an understanding of the operations, system processes and procedures used in areas being audited.
- Review and test for compliance with institutional policies and procedures, applicable laws and regulations through the inspection of physical operations, processes, retrieval and review of documents and investigation of irregularities and errors.
- Compile information and/or prepare reports and analyses setting forth results of compliance audits with appropriate recommendations; perform subsequent audits to ensure complete and appropriate corrective action.
- Develop recommended corrective actions to address issues detected.
- Actively participates in exit conferences, providing clarification and supporting information necessary.
- Provide education for providers and staff
Work requires a general business background generally equivalent to a Bachelor's degree in a business administration, accounting, management, healthcare administration, other related degree.
4 years of experience related to legal, regulatory compliance, or a supervisory role in patient financial services or HIM services
Skills, and Certification: :
- Knowledge of billing compliance, knowledge of Medicare/Medicaid regulations, including billing, coding and documentation requirements. Coding certification (e.g. CPC, CCS, RHIA, RHIT) or applicable coding experience is strongly preferred.
- In depth knowledge of federal regulations
- Strong oral and written communication skills.