Associate Compliance Officer (ACO) Clinical Audit Quality And Revenue Cycle
- Full-Time
- Bethel, CT
- Nuvance Health
- Posted 3 years ago – Accepting applications
Job Description
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) 340B Drug program requirements as outlined by the Health Resources and Services Administration; (ii) Federal healthcare program and private payor requirements and internal policies and procedures as they relate to medical necessity and quality of care; (iii) Medicare and Medicaid conditions of participation; and (iv) supports the SACO and Senior Compliance Officer (“SCO”) in performing risk-based audits to evaluate adequacy and accuracy of clinical documentation in support of services rendered, charged and billed.
Essential Responsibilities
1.Perform 340B Program audits on a regular basis to ensure compliance with 340B Program requirements;
2.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;
3.Conducts targeted risk based audits per the Compliance Department Work Plan and other audits identified by the SACO and SCO across Nuvance Health;
4.Develops and maintains complex audit processes and audit tools;
5.Follows-up on issues identified, areas of potential risk, and post-audit corrective action plan completion under the direction of the SACO. Assists in identifying opportunities for process improvement and education in execution of regulatory requirements;
6.Develop, implement, and conduct Nuvance Health-wide training and education on compliance issues related to quality of care, medical necessity, medical record documentation, credentialing; and employee health screening;
7.Provides support to the SACO and SCO for government audits such as OIG, RAC, MAC CERT ZPIC and other supplemental contractors. When notified of external regulatory request 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;
8.Interacts and effectively communicates with external and regulatory auditors, Nuvance Health Physicians, Nurses, and other clinical practitioners, Managed Care, Revenue Cycle, Information Technology, Coding and Documentation and Denial Management;
9.Fulfills all compliance responsibilities related to the position;
10.Maintain and Model Nuvance Health Values;
11.Demonstrates regular, reliable and predictable attendance;
12.Performs other duties as required.
Education and Experience Requirements:
The successful candidate shall hold the following certifications and/or licenses:
·
Registered as a Nurse, Pharmacist, 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:
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.
Apply to this Job
Purpose:
Consistent with legal requirements and compliance program best practices, this position is necessary for Nuvance Health to ensure integrity and compliance with: (i) 340B Drug program requirements as outlined by the Health Resources and Services Administration; (ii) Federal healthcare program and private payor requirements and internal policies and procedures as they relate to medical necessity and quality of care; (iii) Medicare and Medicaid conditions of participation; and (iv) supports the SACO and Senior Compliance Officer (“SCO”) in performing risk-based audits to evaluate adequacy and accuracy of clinical documentation in support of services rendered, charged and billed.
Essential Responsibilities
1.Perform 340B Program audits on a regular basis to ensure compliance with 340B Program requirements;
2.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;
3.Conducts targeted risk based audits per the Compliance Department Work Plan and other audits identified by the SACO and SCO across Nuvance Health;
4.Develops and maintains complex audit processes and audit tools;
5.Follows-up on issues identified, areas of potential risk, and post-audit corrective action plan completion under the direction of the SACO. Assists in identifying opportunities for process improvement and education in execution of regulatory requirements;
6.Develop, implement, and conduct Nuvance Health-wide training and education on compliance issues related to quality of care, medical necessity, medical record documentation, credentialing; and employee health screening;
7.Provides support to the SACO and SCO for government audits such as OIG, RAC, MAC CERT ZPIC and other supplemental contractors. When notified of external regulatory request 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;
8.Interacts and effectively communicates with external and regulatory auditors, Nuvance Health Physicians, Nurses, and other clinical practitioners, Managed Care, Revenue Cycle, Information Technology, Coding and Documentation and Denial Management;
9.Fulfills all compliance responsibilities related to the position;
10.Maintain and Model Nuvance Health Values;
11.Demonstrates regular, reliable and predictable attendance;
12.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 in, nursing, pharmacy, or other allied health field (e.g., respiratory therapist, physical therapist, occupational therapist, physician assistant):
- Microsoft Office, Word, MS Excel, PowerPoint, excellent verbal and written communication skills, and Presentation skills, a strong knowledge base in: of clinical audit, revenue integrity audit, clinical record documentation, Medicare Conditions of Participation, Medicare & Medicaid billing guidelines and regulations.
The successful candidate shall hold the following certifications and/or licenses:
·
Registered as a Nurse, Pharmacist, 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.
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.