COMPLIANCE AUDITOR SR

Overview

Compliance Auditor Sr.

Full Time, 80 Hours Per Pay Period, Day Shift

Covenant Health Overview:

Covenant Health is the region’s top-performing healthcare network with 10 hospitals, outpatient and specialty services, and Covenant Medical Group, our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned integrated healthcare delivery system and the area’s largest employer. Our more than 11,000 employees, volunteers, and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million patients and families we serve every year. Covenant Health is the only healthcare system in East Tennessee to be named a Forbes “Best Employer” seven times.

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Position Summary: 

Performs complex level professional internal auditing. Work involves leading or conducting compliance audit projects for Covenant Health entities as they relate to charging, coding, documentation and billing compliance. Also provides consulting services to the organization’s management and staff and coordinates requested investigations and educations. Maintains all organizational and professional ethical standards. Works with Covenant leaders and coworkers to coach, mentor, and train department staff. Works independently under limited supervision with significant latitude for initiative and independent judgment. Reports to the Compliance Audit Manager.

Responsibilities

• Identifies and evaluates company risk areas and provides auditing procedures related to documentation, coding and billing including reviewing and analyzing findings.
• Reviews and studies all information published by the federal government, fraud alerts, legal advisory opinions, and other publications related to coding, billing and reimbursement compliance, staying abreast of current regulations.
• Performs research and analysis of charges, CPT coding, modifiers, etc. through internal billing data and risk analyzer software to ensure compliance with Medicare, Medicaid guidelines and other insurance payors.
• Coordinates with appropriate parties to complete over or under payments of claim errors identified during audits in accordance with Audit Policy.
• Communicates or assists in communicating the results of audit projects via written reports to physicians, clinical management and presents (as needed) to related compliance committees.
• Documents all audit activities in a designated location; reports statistics and identified problems as directed by the Audit Workflow Process and Policy.
• Monitors audits performed at the department level in order to ensure that data is appropriate, maintained and disseminated to leadership as indicated.
• Assists with special projects as requested by leadership.
• Works in conjunction with health information management, patient accounting, information systems and other personnel to assist with implementation of solutions to mitigate risk.
• Under the direction of leadership, reviews and evaluates ongoing activities involved in the baseline and periodic compliance audits and compliance programs as deemed appropriate by manager.
• Provides leadership to the audit team and assists with training of coworkers to include new employee orientation, systems overview and production of written deliverables.
• Advises, educates and acts as clinical/billing liaison between system-wide facility leaders, department managers and billing staff as designated by manager in relation to audit findings and process improvement initiatives.
• Motivates coworkers and promotes a team effort in accomplishing goals and deadlines with accuracy, dependability and professionalism.
• Maintains lines of communication with Facilities/Clinics in an ongoing effort to improve the overall quality of customer service.
• Demonstrates consistent aptitude in performing with minimal supervision and oversight while making independent decisions.
• Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested.
• Performs other duties as assigned.

Qualifications

Minimum Education:

Must be sufficient to meet the standards for achievement of the below indicated license and/or certification as required by the issuing authority.

Minimum Experience:

Five (5) years’ experience in health care. Good working knowledge of healthcare billing, Medicare/Medicaid billing guidelines, and other Third Party Payor rules and Regulations. Experience in problem solving and analytical reviews. Must be knowledgeable in use of PC’s, Windows, Excel and Word Processing. Must have good public relations skills.

Licensure Requirement:

Must have certification (RHIT, RHIA, CCS or CPC) in field of healthcare related study or current clinical license/registration in the State of Tennessee as RN with equivalent coding experience.