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
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.
the direction of the Director of Audit Services, supervises the day-to-day
activities of the Ethics and Compliance Billing Compliance Monitors.
and implements effective auditing and monitoring activities of the
healthcare services billed system-wide.
audit tools, methodologies and reporting mechanisms to ensure efficient
and monitors quality assurance and productivity standards of the work
assigned to the Billing Compliance Monitors.
in the development of the Ethics and Compliance work plan.
staffing needs to meet completion of the relevant Ethics and Compliance
work plan items.
maintains and effectively communicates relevant billing and coding
policies and procedures.
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 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.
and coordinates effective educational and training programs for all staff
on documentation guidelines and accurate coding requirements.
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.
confidential reports summarizing the findings of audits and/or special
chart reviews and ensures information is communicated accurately.
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.
and collaborates on billing and coding issues through the SporC and/or
Epical Work Group.
the Physician Billing and Coding Compliance Committee.
in confidential and highly sensitive investigations and/or verification of
reported compliance concerns.
and monitors metrics to assess the effectiveness of the auditing and
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
other functionally related duties as assigned.
Bachelor’s degree in Business, Health Administration,
or related fCHCield or minimum five years of equivalent work experience in lieu
Five years of experience in coding
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
Possesses certification from the American
Academy of Professional Coders (AAPC) or American Health Information Management
Certification in Healthcare Compliance (CHC)
through Health Care Compliance Association (HCCA).
Epic billing systems
need to move around intermittently during the day, including sitting, standing,
stooping, bending, and ambulating.
need to remain still for extended periods, including sitting and standing.
to communicate in face-to-face, phone, email, and other communications.
to read job related documents.
to use computer.