Job Code: 5119
Job Level: G1
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
- 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
- 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
Required Qualifications at this
Work requires a general business background
generally equivalent to a Bachelor's degree in a business administration,
accounting, management, healthcare administration, other related degree.
Four years of experience related to
legal, regulatory compliance, patient advocacy, supervisory role in patient
financial services or HIM services, or other relevant experience.
Degrees, Licensure, and/or
Knowledge, Skills, and Abilities
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 experience is preferred.
In depth knowledge of federal
Strong oral and written
Distinguishing Characteristics of
Coding certifications (e.g. CPC, CCS, CIC, RHIA, RHIT) and coding experience is strongly preferred.