Compliance Auditor II

JOB SUMMARY

Compliance Revenue Cycle Auditor will assist in the overall quality, compliance, and auditing activities to assess compliance of standard operating procedures, corporate policies, industry standards, and applicable federal and state laws for CHRISTUS Health. Conducts revenue cycle audit activities and prepares reports summarizing audit results. Works in conjunction with Director, Compliance Audit on revenue cycle compliance work plans, staff education, internal and external audits and reviews, and provides assurance that the organization is operating in an efficient and effective manner.

MAJOR JOB RESPONSIBILITIES:

• Performs revenue cycle compliance audits according to the established work plan and ad hoc audits as needed, coordinates with the CHRISTUS Regional teams and the System Office as it relates to such audits, and prepares deliverables related to audit results including corrective action plans agreed to by revenue cycle leadership.
• Coordinates targeted internal medical record and claim reviews with the CHRISTUS revenue cycle departments.

• Identify risks related to the revenue cycle and assists with developing annual work plan to address those identified risks.

• Participates in regular compliance / revenue cycle workgroups and presents summary of compliance audit activities to the committee.
• Provides subject matter expertise / education to the facility staff as directed by the Director, Compliance Audit.
• Exercises due diligence in collaboration with the Director, Compliance Audit to prevent and detect misconduct and wrongdoing. Undertake all reasonable steps to respond appropriately when an offense is detected and prevent future similar offenses. Assess the enforcement of compliance program standards.
• Provides results of audits and education to HIM, Revenue Cycle Departments, physicians, hospital and clinic operations regarding revenue cycle requirement in conjunction with the Director, Compliance Audit.
• Assists department with development of corrective action plans (CAPs), as needed, and validate CAPs are implemented and successful by performing follow up audits.
• Communicates effectively with the regional compliance teams, Corporate Compliance team in the System Office, and hospital departments as needed following the CHRISTUS Core Values.
• Assists Director, Compliance Audit on OIG and other government audits/reviews and other compliance-related work, as assigned.
• Maintains confidentiality and discretion regarding all work matters. 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.
• Assesses compliance with policies, procedures, and standards as promulgated by state and federal agencies, the hospital, and other regulatory entities.
• Performs other duties as assigned.

Requirements:

• Bachelor’s degree is preferred, though experience in healthcare revenue cycle, auditing, hospital operations will be considered
• Knowledge of and experience with Epic preferred
• Strong Skills with Microsoft products (Excel, Word, and Power Point)
• Five (5) years’ experience or more in healthcare revenue cycle
• Strong knowledge of revenue cycle regulatory requirements and operations required
• Knowledge of processes related to billing, including, but not limited to registration, CDM management, Local and National Coverage Decisions, Advanced Beneficiary Notices, Medicare Secondary Payor requirements, third party collections and write-offs, No Surprise Act and Pricing Transparency
• Overall knowledge of hospital department operations
• CHC or other hospital revenue cycle certifications preferred