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Compliance Auditor

Richmond, VA, United States

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Description

SHIFT: No Weekends

SCHEDULE: Full-time

Henrico Doctors’ Hospital is a 340-bed Level II Trauma Center offering a full range of healthcare services. We offer specialized vascular surgery, Neurosurgery, a comprehensive certified stroke center, orthopedics and groundbreaking diagnostic imaging. We're also a national trendsetter in kidney transplants through the Virginia Transplant Center and as part of the Virginia Institute of Robotic Surgery; we lead the state in minimally-invasive procedures with da Vinci robotic-assisted surgeries.
 
SPECIFIC ELEMENTS AND ESSENTIAL FUNCTIONS
 
  • Responsible for oversight for facility compliance of REGS.GEN.002 (Medicare – National & Local Coverage Determination)

**Notification/distribution/education of NCD/LCD that apply to the hospital’s services, procedures and devices.

**Establish responsibility/accountability of compliance with the NCDs/LCDs

**Aid in establishing processes/procedures to perform medical necessity review prior to performing a service, procedure, or device & HINN/ABN are given before services are rendered.

**Utilize trended data to identify root cause & develop education &/or assist in developing process improvement in workflow to minimize write-offs

**Review MSC write-off report on a monthly basis to identify education/billing opportunities for Pt Access, departmental services, Coding, & validation of NCD/LCD edit application.


  • Attend designated department meetings related to write-offs and process improvement
  • Work in conjunction with various departments to establish pricing for CFO approval.
  • Participate in all “new business” ventures to determine compliance related to Provider Based requirements, charge structure, reimbursement

**Perform post implementation audits to validate charge capture & documentation meet agreed upon criteria and follow reimbursement.

  • Manage the Labor and Delivery charge capture process
  • Assist with the Observation charge capture process
  • Participate in unbilled management

**Weekly analysis of accounts on HOLD

**Serve as liaison between RPAS/HSC staff and facility related to charge    capture/documentation issues


  • Special projects as assigned by CFO/VP of Finance

Qualifications

REQUIRED SKILLS include:

    • Clinical background or understanding of clinical operations
    • Strong communication skills with hospital and medical staffs
    • Understanding of services, procedures and devices provided by the hospital
    • Ability to understand implications of NCDs and LCDs to hospital and hospital departments
    • Capability to summarize requirements of NCDs/LCDs for education of relevant hospital departments and staff.
    • Ability to use tools and resources pertaining to NCDs/LCDs which are available on Regs website, CMS’ website, Medicare Contractor’s website, etc.
    • Ability to develop and deliver hospital specific educational materials
    • Ability to manage multiple tasks and projects in a fast paced environment.
    • Strong communications skills
    • Professional in appearance and manner
    • Strong organizational skills
    • Ability to work well independently and as a group

    EXPERIENCE
    Required –
    5 years charging/auditing experience in an acute care hospital.
    5 years of nursing or clinical experience in an acute care hospital setting.
     
    EDUCATION
    Required –
    Nurse (RN/LPN), Allied Health Professional or coding certification with coding &/or charging experience
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    Facility: Henrico Doctors Hospital Forest
    Job ID: 00448-45685
    Category: Case Management
    Contract: Full-time
    Shift: No Weekends
    Job Class: Regular

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