• Supports the LifeBridge Health Institutional Compliance. The auditor works under the under general direction of the Director of Institutional Compliance to perform institutional (e.g., hospital, post-acute care (DME, Home Health, etc.) compliance related audit activities to ensure compliance with federal health care program requirements and federal and state laws and regulations.
• Responsible for researching, analyzing, and compiling audit topic specific information, developing audit tools, conducting audits, analyzing findings to determine compliance with applicable laws, regulations, and/or documentation/coding/billing requirements or other requirements, drafts recommendations, and drafts audit reports.
• Develops and conducts education.
• Provides guidance to department representatives specific to their departmental needs and provides ongoing education and compliance training.
• Monitors and keeps up to date with federal health care payor regulations, standards and guidelines as well as communicates and distributes information related to the updates to the appropriate staff and leadership of the effected organization.
• Supports the Compliance Officer/Compliance Leadership with investigations of potential non-compliance. .

KEY RESPONSIBILITIES:

• Conducts outpatient and inpatient hospital, post-acute care (DME, Home Care, etc.), and other facility or specific program audits as assigned.
• Analyzes audit findings and determines if auditee is compliant with applicable laws, regulations, and/or documentation/coding/billing requirements or other requirements.
• Prepares draft reports in accordance with Institutional Compliance work standards.
• Participates in exit meetings with auditees.
• Researches, compiles, analyzes, and drafts audit topic specific information in preparation for completing assigned audits.
• Researches audit topic to determine applicable requirements and regulations, obtains internal information necessary for audit, and develops draft audit tool(s).
• Contributes to the audit plan (scope, time period for review, sample and sample size, etc. ) and analyzes audit data file(s) for accuracy of inclusion of requested data elements and identifies any trends/patterns.
• Develops and conducts compliance education as assigned, for clinicians, leadership, employees, and others.
• Reviews, researches, and compiles local, state, and federal regulatory information; coding, billing, and documentation requirements; and other related information.
• Analyzes regulatory and other pertinent information and drafts a summary of requirements.
• Conducts education in relation to audits, compliance inquiries, institutional policies and requirements related to laws, regulations, etc.
• Researches and responds to compliance inquiries. Reviews, researches, and responds to regulatory, billing, coding, documentation, and other inquiries from providers, leadership, employees, and others within the LifeBridge Health System.
• Supports the Compliance Officer/Compliance Leadership with the investigation of any issues of potential non-compliance.
• Completes all assigned investigational tasks timely.
• Conducts research related to the topic under investigation.
• Conducts audits as part of an investigation to determine compliance with coding, billing, and documentation regulations/guidelines.
• Continuously seeks opportunities to build internal and external relationships and maintain industry knowledge to perform all assigned tasks.
• Maintains basic knowledge of Local, State and Federal laws and regulations, the Centers for Medicare and Medicaid Services’ (CMS) conditions of participation and payment for hospitals, and Long-Term Care regulations.

REQUIREMENTS:

• Education: Associate's degree.
• Experience:
• Knowledge of general health care, overall hospital operations, medical record coding, revenue cycle processes and knowledge of State and Federal laws/regulations preferred.
• Working knowledge of and experience working with Medicare guidelines and publications.
• 1-3 years of relevant experience; experience in hospital operation roles, revenue cycle, auditing, coding, and/or compliance preferred.
• Compliance/Coding certification or equivalent certification preferred. CHC (Certified in Healthcare Compliance), COC (Certified Outpatient Coder) or CCS (Certified Coding Specialist) preferred.
• Ability to work independently on assigned tasks, manage time efficiently to meet assigned task deadlines, and to accept direction on any given assignment.
• Must be organized, detail-oriented and be able to adapt to changing priorities and responsibilities.
• Strong verbal and written communication as well as analytic skills.
• Strong skills with Microsoft Office applications, particularly Excel.
• Ability to work in a team environment.
• Working knowledge of Cerner and/or other EMRs.

Salary range $70 to $88K