Auditor II- Hospital Compliance

Job Summary

Performs proactive and ad hoc internal compliance audits to assess the operational effectiveness of the compliance program and assists in the investigation of reported compliance issues. Supports the compliance program by developing auditing and monitoring tools that are aligned with State and Federal regulatory standards.

Physical Requirements

• The ability to perform the duties and responsibility of the position, with or without reasonable accommodations for disabilities. 


• The ability to consistently lift, push or pull loads of up to fifty (50) pounds. (Unless nursing 50)


• Sufficient strength, mobility and stamina to make frequent location and position changes, assist with patient care, and perform other physical activities of average difficulty.  


• Candidates whose disabilities make them unable to meet the requirements will still be considered fully qualified if they can perform the essential functions of the job with reasonable accommodations.


• May be exposed to infectious or contagious disease.


• May have to handle emergency situations.


• May be subject to irregular hours.


• May be required to wear protective equipment such as eye protection, face protection, masks, sterile/nonsterile gloves, isolation gowns.


• May be exposed to toxic/caustic/chemicals/detergents.            


• Physical activities include continuous sitting, and occasional walking, standing, bending, squatting, climbing, kneeling and twisting.


• Activity Conditions (Occasionally, Frequently, Continuously):
  
  
  
  • Sitting- Continuously 
  
  
  • Walking- Occasionally  
  
  
  • Standing- Occasionally 
  
  
  • Bending-Occasionally 
  
  
  • Squatting- Occasionally 
  
  
  • Climbing-Occasionally
  
  
  • Kneeling-Occasionally
  
  
  • Twisting-Occasionally
  
  

Visual and Hearing Requirements

• 
  

  Must be able to see with corrective eye wear.



• 
  

  Must be able to hear clearly with assistance.

Working Conditions

Primarily Works in a well-lighted and air-conditioned environment with period of heavy workload and stress. This role may include working in less-than-ideal home conditions, which can include exposure to extreme temperatures and environments that may not meet typical cleanliness standards such as clutter, unkept surfaces, and homes with pets. Works in various conditions. 

Performance: Essential Functions

Decision Making: Ability to make decisions and takes appropriate action based on the information they have. Recognizes own limitations and consults with the supervisor, manager, or team member when appropriate.

Time Management: Works efficiently and manages duties to ensure that tasks are completed with accuracy and within the scheduled shift or reasonable amount of time.

Quality & Quantity: Demonstrates accurate, knowledge and skill to carry out job duties. Follows departmental work policies and procedures. Speed and consistency of output and time utilization of job duties.

Computer Knowledge & Electronic Equipment Use: Demonstrates ability to consistently utilize electronic equipment and online computer programs to perform job duties, including electronic documentation, and order entry.

Resource Utilization: Consistently utilizes and maintains supplies and equipment to minimize lost charges and unnecessary equipment repair-replacement.

Confidentiality: Adheres to established policies on privacy and security requirements for compliance with the Health Insurance Portability and Accountability Act (HIPAA), as applicable by Shannon Policy.

Supervises the Following Positions

Positions: N/A

Performance: Position Specific Essential Functions

• Conducts audits and investigations to identify and resolve compliance-related issues

• Applies knowledge of Regulatory standards and concepts of Prospective Payment Systems, including but not limited to, Ambulatory Payment Classifications and Diagnostic Related Groups. 

• Applies knowledge of reimbursement/billing requirements for government-sponsored payors such as Medicare, Medicaid, and Tricare.

• Conducts ongoing audits for the hospital and clinic as required to monitor areas of risk, including but not limited to: 

  • Privacy & Confidentiality

  • Coding, Billing, and Medical Necessity

  • OIG Work Plan, Anti-kickback Statute, Stark Law, etc.

• Properly escalates higher priority items to Compliance Manager, and CCO as required

• Ensures all audits are documented and completed in MDaudit software and performs follow-up as required for escalated issues

• Ensures that Privacy/User Access related items are reviewed and documented in Secure Link software and escalated as required

• Partners with department and practice managers to ensure that action plans are created and implemented for any needed change where potential risks may occur or are identified

• Prepares and reports on audit activities to the Compliance Committee

• Maintains work papers and documentation in an organized manner, ensuring documentation is clear, thorough, and timely.

• Performs other duties as assigned.

Qualifications

Education

• • High School Diploma, GED, or equivalent

  • Associate's degree in Nursing

• Preferred

  • Bachelor's degree in Nursing, Health Information Management, or related field 

Experience: 

• Preferred

  • Three years of experience in Auditing 

Certification/Licensure:

• • Licensed Vocational Nurse (LVN), with authorization to practice in the State of Texas

• Preferred

  • Registered Nurse (RN), with authorization to practice in the State of Texas

  • Certified in Healthcare Compliance (CHC)