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WVU Medicine · 3 months ago

Enterprise Provider Compliance Auditor-Educator (Morgantown, WV)

Morgantown, WV

Full-time

Onsite

Senior Level

5+ years exp

WVU Medicine is seeking an Enterprise Compliance Auditor/Educator to assist with the implementation and facilitation of ongoing compliance auditing and education related to provider services. The role involves conducting compliance audits, developing educational programs, and ensuring adherence to federal healthcare regulations.

Health CareHospitalMedical

Responsibilities

Conducts compliance-related audits and reviews. Coordinates with departments to conduct compliance audits and reviews. Such reviews take into consideration the rules and regulations for CMS, multistate (WV, OH, PA, MD, etc.), and payor specific regulations for chart documentation, valid coding and billing, and medical necessity support to prevent fraud, waste, and abuse as mandated by OIG compliance program requirements. Coordinates with departments to conduct audits across WVUHS and all its affiliates

Coordinates with departments to conduct compliance audits. Evaluates the scope of the audit and develops/completes the required compilation of data analytical reports (independently of IT and/or Data Analytics) from the appropriate application or software in order to identify the audit universe and then select the appropriate sample based on the scope of the audit criteria

Formulates and defines, along with the Director of Provider Compliance and VP of Corporate Compliance, the scope and objectives of audit or review

Researches regulatory requirements that pertain to the audit or review

Reviews medical record, billing, or other relevant documentation

Develops and writes audit reports which outline audit findings, recommendations and corrective actions as needed

Leads and conducts meetings with respective departments or individuals to review audit reports and develop corrective action plans as necessary

Planning, developing and conducting presentations for internal and external departments

Coordinates educational activities with the Director of Provider Compliance and VP of Corporate compliance to ensure organizational compliance education needs are met

Conducts and/or facilitates audit training/education activities of the Compliance Department which may include individual or group training based on the results of internal audit reviews

Reviews clinical issues with physician to ensure appropriate physician documentation, coding, and reimbursement

Conducts and/or facilitates educational activities of the Compliance Department which may include individual, group, and/or online training development

Assists in planning of informational programs, education, and training sessions to educate staff, both departmentally and institution wide, of current and changing compliance and regulatory requirements

Develops and conducts ongoing compliance, documentation guidelines and billing education for new staff, including physicians, allied health and advanced practice professionals, and coding personnel. Additionally the auditor/educator assists with auditing and education, and acts a subject matter expert to the Enterprise Information Management team for both professional and hospital coding

Development of Policies/Procedures

Assists in review of new or revised regulations or policies issued by regulatory agencies to determine how they apply at UHA and as necessary, other provider groups

Conducts ongoing auditing, monitoring, and/or investigations related to compliance with policies and regulatory requirements

Assists in compilation of compliance statistics, findings, and status updates for reporting. Prepares and submits required information to the Enterprise Director of Provider Compliance summaries of the completed audits to be included in updates provided to specific/designated entities for provider board of director and compliance/audit committees, whether physician practice or hospital based. The summaries include subject background, findings, recommendations, and any corrective actions

Serves as compliance representative on assigned teams or committees to provide input and ensure that reporting systems, procedures, and processes are altered or maintained to ensure compliance with applicable laws, regulations, and policies

Qualification

Multi-specialty codingE&M codingProcedural/surgical codingGovernmental billing regulationsCertified Professional Coder (CPC)Registered Health Information Technician (RHIT)Certified Coding Specialist- Physician (CCS-P)Analytical skillsElectronic medical record systemsProblem solving skillsEffective communication skillsOrganizational skillsTime management skillsPresentation skills

Required

High School Diploma or Equivalent AND Seven (7) Years of extensive experience in multi-specialty coding, E&M coding, procedural/surgical coding, as well as knowledge of governmental billing and coding regulations including the 'Teaching Physician Guidelines' OR

Associate's Degree AND Five (5) years extensive experience in multi-specialty coding, E&M coding, procedural/surgical coding, as well as knowledge of governmental billing and coding regulations including the 'Teaching Physician Guidelines'

Certified Professional Coder (CPC), Registered Health Information Technician (RHIT), OR Certified Coding Specialist- Physician (CCS-P)

Knowledge of related provider healthcare compliance, revenue cycle operations, and auditing techniques required

Analytical and problem solving skills

Effective verbal and written communication skills, as well as interpersonal skills necessary to communicate effectively with all levels of management

Capability of working on assignments of varying difficulty and complexity, while exercising independent judgment

Proficient with personal computers and financial application software

Excellent organizational and time management skills

Excellent presentation skills

Ability to utilize electronic medical record and billing systems

Ability to analyze complex EMR workflows related to documentation, billing and etc