Compliance Audit Manager - FT - Days - Corporate Compliance

Compliance Audit Manager - FT - Days - Corporate Compliance - 22258

US:TX:Edinburg | LEGAL, COMPLIANCE, & RISK | Full Time

Posted 2 days ago

Description

DHR Health - US:TX:Edinburg - Days

Summary:

MISSION STATEMENT:

Our Mission is to improve the well-being of those we serve with a commitment to excellence: every patient, every encounter, every time.

VISION:

Our Vision is to create a world-class health system to advance medicine and increase access for the communities we serve by empowering caregivers to heal through compassion, knowledge, innovation, integrated care and excellence.

POSITION SUMMARY:

The Compliance Audit Manager is responsible for ensuring the accuracy and completeness of clinical coding that results in appropriate reimbursement and date integrity and validation of the coded information for external and internal affairs.

POSITION EDUCATION/ QUALIFICATIONS:

High School diploma or GED required

CCS, CCA, COC or CPC certification required

Three (3) years of hospital coding experience

Good written and verbal communication skills are required.

Ability to read, write and speak English

Ability to communicate clearly and concisely with all levels of management.

JOB KNOWLEDGE/EXPERIENCE:

Outpatient Auditing experience required

Auditing for all outpatient service lines, including Emergency, Day Surgery, Endoscopy, Observation or Single Visits preferred

Extensive knowledge of ICD-10-CM and CPT coding principles and guidelines

Extensive knowledge of reimbursement systems and regulations and policies pertaining to documentation, coding, and billing

Knowledge of database applications and spreadsheet design

Demonstrates commitment to Doctors Hospital at Renaissance Health Systems process by integrating our culture in all internal and external customer interactions

Responsibilities:

POSITION RESPONSIBILITIES:

Develop, conduct, and oversee retrospective revenue cycle audits, prospective (pre-bill) audits, and coding validation activities, including Cerner Charge Assist reviews, for high-risk and below-benchmark Evaluation and Management (E/M) services. Communicates audit findings, educational recommendations, and corrective feedback to providers and leadership to promote coding accuracy, documentation integrity, and regulatory compliance.

Monitor and tracks Recovery Audit Contractor (RAC) audit findings, results, and corrective action plans; maintains documentation and reports outcomes to support compliance initiatives.

Manage outsourced audit activities by providing quality oversight, educational feedback, and corrective guidance to external auditors.

Monitor CMS Targeted Probe and Educate (TPE) topics and conduct focused outpatient and inpatient E/M audits to ensure compliance with regulatory requirements.

Perform data analysis of coding accuracy, billing performance, reimbursement outcomes, denial trends, and provider documentation patterns to identify risks and opportunities for improvement.

Design, develop, and maintain audit tools, reports, and monitoring processes to evaluate the accuracy of clinical coding and documentation practices.

Monitor Tableau dashboards and distribute provider census metrics, physician documentation delinquency reports, and other operational performance data.

Communicate audit findings, compliance recommendations, coding guidance, and documentation best practices to physicians, providers, leadership, and staff.

Conduct new physician orientation and onboarding education on coding, documentation, billing compliance, reimbursement methodologies, organizational policies, HIPAA privacy and security standards, and regulatory requirements to support accurate documentation, compliant billing practices, and protection of patient health information.

Develop and deliver coding, documentation, billing, and compliance education for resident physicians and Graduate Medical Education (GME) programs.

Serve as a subject matter expert and resource for providers and staff regarding coding standards, documentation requirements, reimbursement methodologies, and regulatory guidelines.

Collaborate with leadership and management to address clinical documentation, coding, compliance, reimbursement, and revenue integrity issues.

Maintain current knowledge of coding guidelines, CMS regulations, payer requirements, reimbursement methodologies, and industry best practices.

Adhere to AHIMA Standards of Ethical Coding, official coding guidelines, regulatory requirements, and organizational policies.

Support professional development initiatives through continuing education, mentoring, precepting, competency development, and departmental goal achievement.

Other duties as assigned.

LINES OF REPSONSIBILITIES:

1. VP Chief Compliance Privacy Officer

Other information:

CUSTOMER SERVICE:

Provide excellent customer service to all DHR customers. All employees are required to attend the DHR C.A.R.E.S program which outlines the Customer Service Principals including: Commitment, Accountability, Respect, Excellence and Service.

AGE SPECIFIC:

Employees must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served in his/her assigned unit. The individual must demonstrate knowledge of principles of growth and development over the life span and possess the ability to assess data reflective of the patient’s status and interpret the appropriate information needed to identify each patient’s requirement relative to his or her age.

AMERICANS WITH DISABILITIES ACT: (ADA):

A. Essential Duties: Indicated by bold print within performance standards, preceding individual numbered criteria.

The following table provides physical requirements that will be associated with, but not limited to, this position:

Light/moderate lifting up to 20 lbs., from the floor to shoulder height.

Yes

Kneeling

Yes

Must be able to assist other employees with lifting more than 20 lbs.

Yes

Walking

Yes

Light/moderate carrying up to 20 lbs.

Yes

Yes

Straight pulling

Yes

Yes

Pulling hand over hand

Yes

Pushing

Yes

Repeated bending

Yes

Yes

Reaching above shoulder

Yes

Yes

Yes

Climbing Ladders

No

Dual simultaneous grasping

Yes

Depth Perceptions needed

Yes

Ability to see

Yes

Yes

Operating office equipment

Yes

Twisting

Yes

Operating mechanical equipment

Yes

No

Ability to read and write

Yes

Ability to Count

Yes

Ability to hear verbal communication without aid

Yes

Operating Personal Vehicle

Yes

Ability to comprehend written/verbal communication

Yes

Other: Ability to deal with stress

Yes

OSHA Category

III

B. Working Conditions: The individual spends over 95% of his/her time in an air-conditioned environment with varying exposures to noise. There is protection from weather conditions but not necessarily from temperature changes. The position does have low exposure to malodorous, infectious body fluids from patients and some minimal exposure to noxious smells from cleansing agents.

C. Occupational Exposure: This position has minimal to no exposure to blood, body fluids, or tissues and is an OSHA Category III (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Person who performs these duties are not called upon as part of their employment to perform or assist in emergency medical care or first aid or to be potentially exposed in some other way.

Intelligence: General learning ability: The ability to “catch on” or understand instructions and underlying principles. Ability to reason and make judgments. 3

Verbal: Ability to understand meanings of words and ideas associated with them, and to use them effectively. To comprehend language, to understand relationships between words, and to understand meanings of whole sentences and paragraphs. To present information or ideas clearly. 3

Numerical: Ability to perform arithmetic operations quickly and accurately. 2

Spatial: Ability to comprehend forms in space and understands relationships of plane and solid objects. Frequently described as the ability to “visualize” objects or two or three dimensions, or to think visually of geometric forms. 2

Form Perception: Ability to perceive pertinent details and objects or in pictorial or graphic material to make visual comparisons and discriminations and see slight differences in shapes and shadings of figures and widths and lengths of lines. 3

Clerical Perception: Ability to receive pertinent details and verbal or tabular material. To observe differences in copy, to proofread words and numbers, and to avoid perceptual errors in arithmetic computation. 2

Motor Coordination: Ability to coordinate eyes and hands to fingers rapidly and accurately in making precise movements with speed. Ability to make a movement response accurately and quickly. 3

Finger Dexterity: Ability to move hands easily and skillfully. To work with fingers in placing and turning motions. 3

Manual Dexterity: Ability to move hands easily and skillfully. To work with hands in placing and turning motions. 3

Eye-Hand-Foot Coordination: Ability to move the hand and foot coordinately with each other in accordance with visual stimuli. 3

Color Discrimination: Ability to perceive and respond to similarities or differences in colors, shapes, or other values of the same or different color. To identify a particular color, or to recognize harmonious or contrasting color combinations, or to match color adequately. 3