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Director of Compliance Auditing

Company: Renown Health
Location: Reno
Posted on: February 16, 2020

Job Description:

Director of Compliance AuditingRequisition id: 150879Department: 100603 Corporate ComplianceFacility: Renown HealthSchedule: Full TimeShift: DayCategory: ManagementLocation: Reno,NVPosition Purpose Under the direction of Compliance leadership, the Compliance Director will assist with day to day management of the compliance program with direct responsibility for administering the monitoring and auditing program.Nature and Scope The Compliance Director directs the Compliance Auditing staff and is responsible for ensuring compliance with company policies and procedures while also tracking and auditing coding and documentation practices to ensure optimal legal charging for services. The Compliance Director also coordinates shared activities and accountability with operations, clinical leadership, revenue cycle management and staff, and other departments to promote appropriate coding and documentation performance.Additionally, the Compliance Director will monitor and stay abreast of governing regulations and will be responsible for providing coding related education. From time to time, the Compliance Director will conduct or lead compliance related investigations Additional responsibilities include:Manages and develops Compliance Auditing staff to sustain an effective auditing and monitoring programOversees monitoring and auditing activities focusing on coding accuracy and compliance with approved Official Coding Guidelines and AHA Coding Clinic guidance.Implements focused chart reviews and other procedures as appropriate to monitor compliance and control effectiveness to address these areas of risk and vulnerabilities.Manages quality audit assessments for DRG validation, coding accuracy and compliance with approved Official Guidelines for Coding and Reporting, AHA Coding Clinics, and other recognized resources including regulatory agencies and in accordance with Renown coding policies.Schedules and coordinates external coding audits providing account sample for audits and scheduling coder education sessionsProduce reviews of EM coding and documentation audits for all Renown providers and facilities.Identifies trends, patterns and variances in coding and documentation and provides education where necessaryConducts or directs special reviews of charts as needed for specific identified concerns.Directs compliance issues to appropriate channels for investigation and resolution.Conduct meetings with providers to review coding and documentation issues, and educate on governmental and managed care specific requirementsConducts education in-services with coding and CDI staff at least quarterly and more frequently when audit results indicate necessity. Utilizes relevant publications, such as Official Guidelines for Coding and Reporting, AHA Coding Clinics, etc. for education. .Works closely with CDI team to identify any areas in coding that require documentation improvement and/or coding accuracy.Reviews reports on claim denials to identify compliance issues such as denials due to coding/MS-DRG changesPartners with Health Information Management (HIM) coding management in developing strategy and programs to address non-compliant or high-risk coding practices.Serves as Subject Matter Expert (SME) for various hospital committees/departments to ensure hospital goals and objectives are achieved that rely on coded data including but not limited to: Readmission Reduction, Performance Improvement, and Risk Management.Researches, summarizes and disseminates information regarding new coding requirements (e.g. annual CPT code updates, etc.) and update appropriate management, providers and coding staff of changes.Works with the Chief Compliance Officer/Deputy Compliance Officer in preparing an agenda for the Operational Compliance Committee, the Audit and Compliance Steering Committee and other committee meetings.Assists in the development of annual compliance and audit work plans based on identified risks for the health care industry, medical groups, and/or internal activities and to assess compliance vulnerability.Works with the Organizational Learning department to facilitate appropriate introductory training for new providers as well as ongoing training for providers, monitoring completion rates and taking appropriate action in accordance with policy for anyone not completing required training.Contributes to the development of annual compliance education to communicate identified areas of increased risk or scrutiny by regulators.Maintain a current knowledge of reimbursement trends and opportunities related to coding and documentation.Assists Chief Compliance Officer/Deputy Compliance Officer with the development and maintenance of policies and procedures for the general operation of the Compliance Program and related activities to prevent illegal, unethical, or improper conduct.Leads or conducts compliance related investigationsPromote compliance with federal, state and local practices for throughout the organizationRepresents Renown in community and industry organizations.Adheres to all company policies, including but not limited to, OSHA, HIPAA, compliance and Code of Conduct.Follows the mission, vision, and core values of the organizationDisclaimer The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.Minimum Qualifications Requirements Required and/or Preferred Name Description Education: Must have knowledge of the English language, including reading, writing and speaking English. Associate or Bachelors Degree in Healthcare Business Administration, Finance, or Health Related field or the equivalent combination of training and experience required. Experience: 7-10 years hospital coding experience with 5 years management experience experience in a clinical setting with three years within a Compliance Department.Strong working knowledge of current federal and state regulations and healthcare laws, relevant regulatory guidance, auditing procedures, HIPAA, coding and risk management.Demonstrated knowledge of Medicare and Medicaid reimbursement and fraud and abuse laws. Coding and monitoring/auditing experience is required. Preferred Experience: Epic. Strong preference for eight to ten years of experience in healthcare compliance matters, preferably for a large, multi-faceted healthcare organization.License(s): None Certification(s): Required Licenses/Certifications: AHIMA (CCS) Additional Preferred Licenses/ Certifications: AAPC Coding Certification (CPC) or RHIT/RHIA, CHC. Computer / Typing: Must be proficient with Microsoft Office Suite, including Outlook,PowerPoint, Excel and Word andhave the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.

Keywords: Renown Health, Reno , Director of Compliance Auditing, Executive , Reno, Nevada

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