Sr Corporate Compliance Auditor

Overview: Leads advanced, complex compliance audits and investigations with a primary focus on revenue cycle by reviewing medical records for documentation compliance for CPT, Level II HCPCS, and diagnosis codes determining that regulations are being complied with as evidenced in medical record documentation; and evaluating appropriateness of billing and coding procedures. Requires advanced knowledge of CPT, Level II HCPCS, diagnosis coding, and government payer regulations. Work involves actively directing and conducting compliance audits, investigations, corrective action plans, regulation research, organizational education, and proving consultative services to the organization’s senior leadership, providers and staff; advising and assisting on the development of the Corporate Compliance annual audit work plan, awareness and mitigation of revenue cycle risks; and providing training and coaching to staff. Assists and advises Corporate Compliance Auditors with their audits, projects and investigations. Possesses data analytic and presentation skills. Maintains and promotes all organizational and professional ethical standards. Considered a high level contributor and viewed as an expert internally.
Independently completes assignments, manages audits and projects, performs regulatory research, investigations, participating and collaborating in the claims review process, providing documentation and compliance educational sessions to senior leadership, clinical staff, providers, revenue cycle leadership and staff, auditing and monitoring the quality and data integrity of Fairview’s coding, documentation and billing practices.
Communicates and interacts with wide cross-section of executive leaders, directors, managers, providers and front line staff to fulfill job requirements.Responsibilities/Job Description:

• Works with minimal direction.
• Strong negotiating skills and ability to tactfully resolve problems.
• Ability to define audits, identify potential risk areas, create transparency with operations, understand operational workflows, develop appropriate action plans, document findings, draft reports and communicate results to Leadership (within minimal oversight).
• Liaise with Operations to ensure audit findings are remediated and action plans are sustained and to identify emerging risks.
• Apply judgment to ensure Compliance with coding, documentation, and billing laws, regulations and guidelines that govern Fairview Health Services to safeguard, protect and disclose against fraud, waste and abuse while receiving appropriate reimbursement for the care provided.
• Leads investigations, interviews, reviews documents, and documents key issues and ability to communicate results effectively to front-line staff to senior leaders.
• Skill in conducting quality and thorough audits and reviews by using strong critical thinking skills, operational workflow knowledge, ability to research, as well as negotiating skills.
• Evaluate practice patterns, data-mining, analyzing and present oral and written conclusions to leadership and departments in applying and improving compliance and internal controls. Provide on-going monitoring, as needed.
• Excellent ability to sustain focus and attention to detail.
• Strong ability to problem solve and assess potential risks identified, prioritize concerns, and provide educational needs to various skill levels, such as physician, ancillary, nursing, coding and billing staff.
• Considerable knowledge of and skill in applying and educating on federal and state rules and regulations, coding and billing principles and practices (i.e. AHIMA, AMA, Federal Register, CMS, OIG).
• Act as a resource for documentation, coding, claim review process, and billing questions for all Fairview by staying up-to-date with local, state, federal laws, regulations and guidelines, as well as monitoring payer bulletins, periodicals and web-sites to maintain revenue cycle knowledge.
• Effectively work with and coordinate the activities of external consultants and legal counsel as assigned.
• Excellent written and oral communication and presentation skills a must.
• Team player who has strong negotiating skills and ability to tactfully resolve problems.
• Oversees and evaluates orientation and onboarding of corporate compliance auditors. May provide input in the review and evaluation of corporate compliance auditors performance.
• Leads and works on task forces and committees representing compliance.
• Assist in developing of audit templates and procedures.

Qualifications:
Required

• Bachelor’s Degree or 10 years of coding or auditing experience
• 10 years of coding or auditing experience
• Registered Health Information Administrator (RHIA) Registered Health Information Technician (RHIT), Coding Certification through the AAPC or AHIMA
  

Preferred

• 2 Years Compliance Auditing Experience.
• Data analytics software experience.
• Experience navigating an Electronic Medical Record System.

This position requires remote work. In addition to adhering to all Fairview policies, guidelines, procedures, the Fairview Commitments, and the Code of Conduct, it is the expectation the following requirements of the remote work policy will be met, including but not limited to:

• Remote workspace that is clean, safe, and professional.
• Maintains an internet connection consistent with Fairview standards at remote workspace.
• Remain productive and responsive during their scheduled work hours.
• Attend primary Fairview location, as needed.