Job
Summary:
Under
the direction of the Director of Audit Services, oversees auditing and
monitoring activities to ensure compliance with applicable hospital and
professional billing, and coding rules and regulations. Collaborates with
leadership to ensure execution of an effective compliance program. Upholds the
mission, vision, values, and customer service standards of The MetroHealth
System.
Responsibilities:
- Contributes
to patient safety, by supporting the system-wide programs and policies,
addressing a safe environment for patients and the reporting of safety
concerns to the appropriate individuals.
- Under
the direction of the Director of Audit Services, supervises the day-to-day
activities of the Ethics and Compliance Billing Compliance Monitors.
- Develops
and implements effective auditing and monitoring activities of the
healthcare services billed system-wide.
- Designs
audit tools, methodologies and reporting mechanisms to ensure efficient
audit practices.
- Develops
and monitors quality assurance and productivity standards of the work
assigned to the Billing Compliance Monitors.
- Participates
in the development of the Ethics and Compliance work plan.
- Coordinates
staffing needs to meet completion of the relevant Ethics and Compliance
work plan items.
- Develops,
maintains and effectively communicates relevant billing and coding
policies and procedures.
- Monitors
regulatory communications of the Medicare Administrate Contractor, Ohio
Department of Medicaid, Office of Inspector General and/or other
governmental agencies or private payers through alerts, bulletins,
advisory opinions, or any other means to assess real or potential risk to
the organization.
- Assesses
the work plan of the Office of Inspector General (OIG), Medicare Recovery
Audit Contractors, Medicaid Integrity Contractors or the Comprehensive
Error Rate Testing (CERT) database and develops and assigns auditing and
monitoring projects accordingly.
- Develops
and coordinates effective educational and training programs for all staff
on documentation guidelines and accurate coding requirements.
- Functions
as a resource for staff, clinicians and administration to obtain
information or clarification on accurate and ethical coding and
documentation standards, guidelines, and regulatory requirements.
- Reviews
confidential reports summarizing the findings of audits and/or special
chart reviews and ensures information is communicated accurately.
- Oversees
follow-up audits as necessary to ensure the error rates are decreasing
and/or escalates ongoing or egregious audit findings to the Detected
Deficiency Work Group.
- Communicates
and collaborates on billing and coding issues through the SporC and/or
Epical Work Group.
- Leads
the Physician Billing and Coding Compliance Committee.
- Assists
in confidential and highly sensitive investigations and/or verification of
reported compliance concerns.
- Develops
and monitors metrics to assess the effectiveness of the auditing and
monitoring activities.
- Continuously
seeks opportunities to improve the auditing and monitoring activities and
ensures activities are aligned with the goals and objectives of the Ethics
and Compliance Department as well as the organization while maintaining
audit accuracy.
- Performs
other functionally related duties as assigned.
Qualifications:
Required:
Bachelor’s degree in Business, Health Administration,
or related fCHCield or minimum five years of equivalent work experience in lieu
of degree.
Five years of experience in coding
(CPT-4/ICD-10)
Working knowledge of healthcare reimbursement
and revenue cycle management.
One to two years of supervisory/management or
demonstrated leadership experience.
Proficient with Microsoft Office products.
Strong quantitative skills.
Excellent verbal and written communication
skills.
Possesses certification from the American
Academy of Professional Coders (AAPC) or American Health Information Management
Association (AHIMA).
Preferred:
Certification in Healthcare Compliance (CHC)
through Health Care Compliance Association (HCCA).
Epic billing systems
Physical
Demands:
May
need to move around intermittently during the day, including sitting, standing,
stooping, bending, and ambulating.
May
need to remain still for extended periods, including sitting and standing.
Ability
to communicate in face-to-face, phone, email, and other communications.
Ability
to read job related documents.
Ability
to use computer.