Compliance Auditor II - Compliance

Description Summary: The Compliance Auditor II will assist in the overall quality, compliance, and auditing activities to ensure compliance of standard operating procedures, corporate policies, industry standards, and applicable federal and state laws. Conducts audit activities, reporting and communicates audit findings. Works in conjunction with Compliance Director on compliance work plans, internal and external audits and reviews, and provides assurance that the organization is operating in an efficient and effective manner. Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Manages compliance audit activities pertaining to compliance and coordinates with Corporate Compliance Director and Senior Leadership as it relates to such audits
• Responsible for answering inquiries related to professional documentation, coding, and billing regulatory requirements. Work with VP/Senior/Manager/Director on more complex issues or investigations.
• Assist with data analysis to determine root cause of reported or identified issues and determine level of escalation required.
• Performs and follows established audit work steps and procedures
• Gather all relevant information for potential compliance issues, determine underlying causes, and relate information from different sources to draw logical conclusions.
• Maintain a current understanding of regulatory trends and changes in compliance and regulatory guidelines that affect CHRISTUS and its subsidiaries by monitoring various resources to assess regulatory changes and determine organizational impact.
• Document all issues received, actions taken, and resolutions.
• Collaborates with Compliance Director, VP, Compliance on external audits and reviews, which are initiated by government agencies or government-contracted organizations
• Coordinates and performs timely medical record and claims reviews across CHRISTUS Health departments (HIM, Case Mgt., PFS, CTC)
• Works jointly with Compliance Directors, VP, Compliance on the compliance work plan, risk assessments, and quarterly Board Committee reports
• Assist with the development of dashboards, written reports, or other deliverables to be presented to the department, VP Compliance, Senior Leadership, and/or the Board Committee. Help develop and maintain compliance-related policies and procedures to ensure they are current and relevant. Assist with providing policy-related guidance to individuals and departments.
• Provides feedback to HIM, Case Management, Patient Financial Services (PFS), Revenue Cycle, physicians and Hospital and Clinic operations regarding charging, documentation, patient status and coding issues so 'process improvement' changes are made
• Perform audits and reviews, identify process improvements, and streamline processes.
• Communicates compliance/audit activities and outcomes to departments
• Assists Compliance Director on OIG and other government audits/reviews and other compliance-related work, as assigned.
• Maintains confidentiality and discretion regarding all work matters and works cooperatively with all team members and demonstrates competence to perform assigned responsibilities.
• Takes personal responsibility to ensure compliance with all policies, procedures and standards as promulgated by state and federal agencies, the hospital, and other regulatory entities.
• Performs all duties in a manner that protects the confidentiality of patients and does not solicit or disclose any confidential information unless it is necessary in the performance of assigned job duties.
• Performs other duties as assigned.

Job Requirements:

Education/Skills

• Associate's degree required
• Bachelor's degree preferred

Experience

• Strong interpersonal and written and verbal communications skills required
• Strong data analytics and interpretation skills preferred
• Knowledge and experience in using EPIC, Word, Excel, PowerPoint, PowerBI and similar Office programs preferred

Licenses, Registrations, or Certifications

• RHIT, RHIA, RN, CHC, CPC or similar credential preferred

In accordance with the CHRISTUS Health License, Certification and Registration Verification Policy, all Associates are required to obtain the required certifications for their respective positions within the designated time frame. Work Schedule:
8AM - 5PM Monday-Friday Work Type:
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CHRISTUS Health is an international faith-based, not-for-profit health care system based in Irving, Texas, with more than 60 hospitals in Texas, Louisiana, New Mexico, Chile, Colombia and Mexico. CHRISTUS Health is made up of 50,000 Associates providing compassionate and individualized care at more than 600 centers, including community hospitals, clinics, long-term care facilities and health ministries. Sponsored by the Sisters of Charity of the Incarnate Word of Houston, Sisters of Charity of the Incarnate Word of San Antonio and the Sisters of the Holy Family of Nazareth, our mission is to extend the healing ministry of Jesus Christ to every individual we serve.

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