Comp Audits & Inv Mgr - FT - Days - Corporate Compliance

DHR Health; Edinburg (TX); Sur place; USD 90 000 - 130 000; Plein temps

Résumé du poste

DHR Health in Edinburg, TX, seeks a Compliance Audits and Investigation Manager to oversee coding audits, investigations, and related monitoring across the system. You will lead audit scope design, perform fact-finding, and prepare reports for executive leadership.

The role requires RHIT/RHIA/CIC/CCSP or CIA, with several years in coding/audit within health systems, strong communication, and knowledge of regulatory requirements.

Qualifications

• Five (5) years coding experience in a multi-specialty health system.
• Three (3) years coding auditing experience on a variety of specialties.
• Experience in designing audit scope and methodology.
• Knowledge of applicable laws, rules, best practices and requirements.
• Ability to read, write and speak English.

Responsabilités

• Promote the facility's mission, vision, and values by effectively communicating and demonstrating them in daily operations.
• Lead and conduct coding, billing, documentation, and compliance audits to verify the appropriateness, accuracy, and completeness of coding and charge capture activities.
• Develop and implement detailed audit and monitoring programs to assess compliance with policies, regulatory requirements, and industry standards.
• Conduct audits of medical records, billing and reimbursement activities, and operational processes to evaluate compliance with regulations and internal policies.
• Lead and manage compliance investigations, including regulatory noncompliance and HIPAA privacy concerns.
• Prepare comprehensive written reports summarizing audit and investigation findings and propose corrective actions.

Connaissances

Coding experience

Coding auditing

Regulatory knowledge

Communication skills

English proficiency

Formation

RHIT

RHIA

CIC

CCS

CCSP

Certified Internal Auditor

Bachelor’s Degree (BS/BA) preferred

Outils

Windows-based software

Description du poste

Comp Audits & Inv Mgr - FT - Days - Corporate Compliance - 22259

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

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:

Under the supervision of the Chief Compliance & Privacy Officer, the Compliance Audits and Investigation Manager provides high-level oversight and program coordination related to the implementation, evaluation, and maintenance of the internal coding audit program at DHR Health System and its Affiliates.

POSITION EDUCATION/ QUALIFICATIONS:

RHIT, RHIA, CIC, CCS and/or CCSP.

Certified Internal Auditor certification preferred.

Bachelor’s Degree (BS/BA) preferred

Good written and verbal communication skills required

Ability to read, write and speak English

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

JOB KNOWLEDGE/EXPERIENCE:

Knowledge in applicable laws, rules, best practices and requirements

Ability to communicate effectively in both written and oral formats

Risk Analysis and Management

Internal audit industry perspective

Adaptive to change ability to quickly and effectively adjust behavior or schedule

Five (5) years coding experience in a multi-specialty health system

Three (3) years coding auditing experience on a variety of specialties

Experience in designing audit scope and methodology.

Organizational, analytical, writing and interpersonalskills

Dependable and self-directed

Critical thinking, problem solving and deductive reasoningskills

Basic computer skills – familiarity with Windows based softwareprograms

Knowledge of regulatoryenvironment and healthcare compliance requirements

Responsibilities:

POSITION RESPONSIBILITIES:

Promote the facility's mission, vision, and values by effectively communicating and demonstrating them in daily operations. Considers mission, vision, and values in developing services, standards, and practices.

Lead and conduct coding, billing, documentation, and compliance audits to verify the appropriateness, accuracy, and completeness of coding and charge capture activities while identifying potential compliance risks and opportunities for improvement.

Develop and implement detailed audit and monitoring programs of varying complexity and scope to assess compliance with organizational policies, regulatory requirements, and industry standards.

Conduct audits of medical records, billing and reimbursement activities, and operational processes to evaluate compliance with federal and state regulations, third-party payer requirements, and internal policies.

Lead and manage compliance investigations, including allegations of regulatory noncompliance, HIPAA privacy concerns, documentation issues, billing concerns, and other compliance-related matters.

Perform fact-finding activities, including document reviews, interviews, data analysis, and coordination with internal stakeholders to determine findings and recommend corrective actions.

Oversee the intake, tracking, investigation, resolution, and documentation of compliance and privacy concerns to ensure timely and appropriate disposition.

Participate in the administration and ongoing effectiveness of the Compliance and HIPAA Privacy Programs, including monitoring compliance with applicable laws, regulations, and organizational policies.

Prepare comprehensive written reports summarizing audit and investigation findings, identifies root causes, and works collaboratively with leadership to implement corrective action plans and process improvements.

Research applicable regulatory, documentation, coding, reimbursement, privacy and compliance requirements and incorporate findings into audit plans, investigations, and monitoring activities.

Coordinate audit planning, compliance reviews, investigations, and resolution of findings with the Chief Compliance & Privacy Officer and other organizational leaders.

Review, develop, recommend, and implement policies, procedures, systems, and controls to strengthen compliance, privacy, and revenue integrity processes.

Review documents and information relevant to compliance activities including, but not limited to, patient records, billing records, contracts, marketing materials, vendor arrangements, physician relationships and other business records.

Conduct compliance risk assessments and ongoing monitoring activities to identify emerging risks and evaluate the effectiveness of internal controls.

Provide consultation, education, and guidance to physicians, leadership and staff regarding documentation, coding, billing, HIPAA privacy, regulatory requirements and compliance best practices.

Facilitate one-on-one and group education sessions for physicians, providers and employees regarding compliance, coding, billing, audit findings, and privacy-related requirements.

Maintain a strong understanding of Medicare, Medicaid, commercial payer regulations, reimbursement methodologies, clinical coding requirements, documentation standards, HIPAA privacy regulations and healthcare compliance program expectations.

Build and maintain effective collaborative relationships with physicians, administrators, department leaders and staff to support organizational compliance objectives and foster a culture of integrity and accountability.

Assist with regulatory inquiries, audits, corrective action plans and compliance reporting activities as requested.

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.