Associate Compliance Officer (ACO) Clinical Audit Quality and Revenue Cycle Details

Associate Compliance Officer (ACO) Clinical Audit Quality and Revenue Cycle

Nuvance Health - Bethel, CT

Employment Type : Full-Time

Nuvance Health has a network of convenient hospital and outpatient locations — Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York — plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology care, and two urgent care offices. Non-acute care is offered through various affiliates, including the Thompson House for rehabilitation and skilled nursing services, and the Home Care organizations.

Purpose:
Consistent with legal requirements and compliance program best practices, this position is necessary for Nuvance Health to ensure integrity and compliance with: (i) Federal healthcare program requirements and internal policies and procedures as they relate to medical necessity and quality of care; (ii) Medicare and Medicaid conditions of participation; and (iii) applicable Federal and State clinical laboratory, credentialing, and employee health screening requirements. Reporting to the SACO, the ACO is responsible in supporting and promoting clinical and revenue compliance throughout the Network.

Essential Responsibilities

1.Conduct audits on employee health and safety procedures and regulations according to OSHA standards;

2.Conduct audits on the environmental health safety program according to the requirements by Joint Commission;

3.Performs moderately complex clinical audit activities and work assignments under the direction of the the SACO.Works independently with minimal supervision. Supports SACO with performing Clinical Audit Activities across Nuvance Health, ensuring accurate quality processes and supporting SACO and Senior Compliance Officer (“SCO”) in evaluating adequacy and accuracy of clinical documentation;

4.Conducts targeted risk based audits per Compliance Department Work Plan and other audits identified by SACO and SCO across Nuvance Health;

5.Audits accuracy of documentation, orders, medical record completeness, billing, charging, quantity, revenue codes, etc. Reinforces proper documentation and billing consistent with Nuvance Health Policies, State and Federal Regulatory and Reimbursement Guidelines, maintaining and supporting Compliance throughout the Network;

6.Performs payer audits, applying appropriate Medicare, Medicaid guidelines. Conducts post audit exit conference, and arranges for payments due from or to Nuvance Health and closes out the audit. Effectively communicates audit results to SACO and SCO;

7.Follows-up on issues noted, areas of potential risk, and post audit corrective action completion under the direction of the SACO or SCO. Assists in identifying opportunities for process improvement and education in execution of regulatory requirements; assists in developing and conducting appropriate education;

8.Supports SACO and SCO in performance and completion of the department Work Plan. Assists with ensuring timely and ongoing accuracy of department spreadsheets and database of clinical audit activities; assists in retrieving data and preparing quarterly reports of audit findings and activities for the SACO, SCO in preparation for ERCC and Audit Committee meetings;

9.Provides support to SACO, SCO for government audits such as OIG, RAC, MAC, CERT, ZPIC and other supplemental contractors. When notified of external regulatory requests for medical records, ensures medical records and supporting materials are complete and submitted in a timely manner. Perform pre-audit work and communicates audit requests to SACO and SCO;

10.Performs moderately complex compliance audits, follow-ups with corrective action plans; serves as a resource for documentation criteria for regulatory billing requirements including for new programs or services being implemented by Nuvance Health;

11.Provides support to Revenue Cycle as needed to audit accounts for Patient Requested and Revenue Cycle requested audits.

12.Interacts and effectively communicates with external and regulatory auditors; Nuvance Health physicians, nurses and other clinical practitioners, Managed Care, Revenue Cycle, Information Technology Group, Finance, Coding and Documentation, and Denial Management;

13.Supports the SACO and SCO with the development of, updating, maintaining/disseminating training manuals and education material to Clinical Audit Staff, Operational and Service Departments and Clinicians as directed by SACO or SCO.Assists in the development of Clinical Audit Policies and Procedures and recommends process improvement solutions;

14.Applies principals of independence and Code of Conduct policies in performance of medical audit activity.Maintain confidentiality of all information to include financial, operational, patient registration and clinical information;

15.Maintain and Model Nuvance Health Values;

16.Demonstrates regular, reliable and predictable attendance;

17.Performs other duties as required.

Education and Experience Requirements:

• An Associate’s degree with 5 years of experience or a Bachelor Degree with at least four 3 years of job-related experience;
• An Associate’s or Bachelor’s in nursing or other allied health field (e.g., respiratory therapist, pharmacist, physical therapist, occupational therapist, physician assistant).

Minimum Knowledge, Skills and Abilities Requirements:

• Microsoft Office, Word, MS Excel, PowerPoint, excellent verbal and written communication skills, presentation skills, a strong knowledge base in: of clinical audit, clinical record documentation, Medicare Conditions of Participation; and
• Previous working experience as Environmental Health, Safety and/or Environmental Policy.

License, Registration, or Certification Requirements:
The successful candidate shall hold the following certifications and/or licenses:

Registered as a Nurse, or licensed as another clinical or allied health provider in the State of New York or Connecticut.

Location: Bethel-14 Research Drive

Work Type: Full-Time

Standard Hours: 40.00

FTE: 1.000000

Work Schedule: Day 8

Work Shift: day shift

Org Unit: 239

Department: Corporate Compliance

Exempt: Yes

Working conditions:
Essential:

• Some manual skills / motor coord & finger dexterity
• Little or no potential for occupational risk
• Sedentary/light effort. May exert up to 10 lbs. force
• Generally pleasant working conditions.

EOE, including disability/vets.

We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business. If you believe you require such assistance to complete this form or to participate in an interview, please contact Human Resources at 203-739-7330 (for reasonable accommodation requests only). Please provide all information requested to assure that you are considered for current or future opportunities.