Compliance Auditor - REMOTE

Munson Healthcare Traverse City, Michigan Internal Audit Full-Time Day shift


Requisition #: 42352
Total hours worked per week: 40+

Description

SUMMARY
The Compliance Auditor is well versed in healthcare regulations, policies, and procedures, and serves as a protector of revenue for the Munson Healthcare System (Munson) through the completion of formal audits and the provision of various advisory/consultative services. These audits include medical record documentation, medical necessity requirements, revenue cycle, and operational processes to ensure Munson is compliant with state and federal laws, payer regulations, and other guidance. These audits provide insight into processes, internal controls, and related risk, and assist in preventing, detecting, and correcting risks of non-compliance.

The Compliance Auditor reports on the results of audits and projects using knowledge of best practices to identify issues to improve business operations and minimize risk, and serves as a technical resource on documentation, coding, billing, and general compliance questions. Identifying, analyzing, and assessing complex enterprise-wide environment, responding to regulatory compliance inquiries and issues, and addressing compliance program needs are also functions of this position.

The ideal candidate has excellent leadership and analytical thinking skills; excellent verbal and written communication skills; is flexible and adaptable; and experienced leading and managing compliance initiatives through teamwork, collaboration and open communication.

ENTRY REQUIREMENTS

  • Bachelor's degree required.
  • Minimum of four years of healthcare experience, preferably in compliance, coding and billing, medical record documentation, auditing, or other directly relevant areas.
  • Experience with EHRs, practice management systems, and reporting software is required.
  • Solid knowledge and ability to accurately interpret and implement Federal and State health care regulations, 3rd party payer standards, legal requirements, and policies and requirements pertaining to documentation, coding and billing.
  • Critical thinker with excellent research and analytical skills.
  • Self-starter with demonstrated leadership potential and strong time management skills.
  • Excellent written and verbal communication skills; ability to effectively and collaboratively deal with conflicting views and mediate fair solutions at all levels in the organization, including clinical and nonclinical support staff, practice managers, physicians, and senior leadership.
  • Proficient with computers and various Microsoft Office software, particularly Word, Excel, and
  • PowerPoint. Must be adaptable to learning new software systems, including billing and clinical systems.

ORGANIZATION
The position reports to the System Director - Internal Audit/Corporate Compliance Officer who reports directly to the Munson Healthcare Audit Committee and administratively to the Munson Healthcare CEO. The Internal Audit department serves the all of the Munson Healthcare owned entities as well as our affiliate, Kalkaska Memorial Health Center.

The Compliance Auditor interacts with senior leaders, providers, management and virtually all levels of employees, as well as external parties such as consultants and auditors, in a complex multi-entity environment.      

POPULATIONS SERVED, COMPETENCIES, INCLUDING AGE OF PATIENTS SERVED

     Cares for patients in the age category(s) checked below:
       _X  No direct clinical contact with patients

SPECIFIC DUTIES

1.    Supports the Mission, Vision and Values of Munson Healthcare.

2.    Embraces and supports the Performance Improvement philosophy of Munson Healthcare.

3.    Promotes personal and patient safety.

4.    Uses effective customer service/interpersonal skills at all times.

5.    Design and conduct audits and investigations for compliance with various regulatory requirements, which may include coding and billing rules set forth by Medicaid, Medicare, and commercial payers.

6.    Perform all aspects of the audit including planning and developing the audit program, testing of controls, data analysis, and preparing accurate work papers to substantiate findings including any process gaps and deficiencies.

7.    Generate final written report of audit findings and effectively communicate audit results to a wide audience of internal stakeholders including hospital service line administrators and management, physicians, coders, billing staff, and others as appropriate; evaluate the adequacy of management corrective action to the identified issues. Senior leadership and the Munson Healthcare Audit Committee receive these final audit reports.

8.    Perform follow up procedures on the status of outstanding audit issues and validate that corrective action plans have been implemented and are effective.
 
9.    Establish trusted consultative/advisory relationships in order to serve as a resource for department managers, staff, physicians and administration for information on accurate/ethical coding and documentation standards, guidelines and regulatory requirements.

10.    Research various regulatory or other compliance related questions through the use of internet search engines, provider manuals, coding books, CMS websites and other tools, and prepare complete and accurate responses to stakeholders.

11.    Handle special projects related to clinical documentation, coding and billing, regulatory, and reimbursement-related issues as well as charge capture process, electronic medical record functionality, and the development of documentation and coding tools and templates.

12.    Represent Internal Audit at operational meetings as needed.

13.    Assist in the development of the annual Internal Audit Plan and overall risk assessment for the Munson Healthcare system through review of the OIG Work Plan and other external sources for targeted areas that may affect Munson.

14.    Support external auditors during the annual year-end financial statement audit for the Munson Healthcare system, in the testing of revenue and accounts receivable.

15.    Maintain up-to-date knowledge of compliance issues related to the healthcare industry, annual coding updates and frequent regulatory changes.

16.    Represent Internal Audit at the monthly New Leader Assimilation meeting by presenting an overview of Internal Audit’s structure and services; update presentation as needed.

17.    Performs other duties and responsibilities as assigned.