Job description
SUMMARY
Mentors and trains less experience staff in the execution of responsibilities, provides support in the resolution of complex issues/questions or technical points. Minimizes risk to the organization by conducting Corporate Compliance audits, investigations and training throughout all affiliates. Guides system administration and RGHS management to ensure compliance with local, state and federal laws and regulations; in addition to contract obligations. Acts as subject matter expert for building and continually optimizing the system’s EMR. Work is often confidential and sensitive; therefore requires a high level of professionalism and strong communication skills. Requires a high degree of mental and visual acuity as attention to detail, critical thinking and decision making is required. Errors greatly impact the hospital’s compliance risk, including legal fines, loss of revenue and statistics. Strong analytical skills, project management experience, and training skills to guide Physicians, staff and system Management in interpretation of rules and regulations are essential.
STATUS: Full-Time
LOCATION: Remote
DEPARTMENT: Corporate Compliance
SCHEDULE: Monday - Friday, 8:00am to 4:00pm
RESPONSIBILITIES
Abides by the standards of Ethical Coding as set forth by the American Health Information Management Association.
As senior member, applies mastery of skills in area of specialization, provides guidance and general oversight to less experience employees and may train new employees. The duties and tasks of this senior position reflect substantial variety and complexity. The senior serves as a resource to others in the resolution of complex issues and technical skills.
Manages projects independently, prepares governmental disclosures and facilitates external audits by regulatory agencies while working with RGHS Administration and Management.
Coordinates and conducts audits to assess compliance with payer regulations and contract obligations. Audits include, but not limited to revenue cycle (Clinical documentation, EMR work flows, registration, coding, charging, billing, payments and denials), financial statements, payments and attestations; grants, RGHS employees and contractors for governmental exclusions and payment agreements
Interviews key staff with professionalism and respect in order to identify cause analysis of issues identified.
Collaborates with health care professionals to discuss findings and offer advice and education as to how to improve compliance
Develops reports reflecting audit results and reports findings to Compliance Director, RGHS Administration and management
Develops corrective action plans with Management and assists with implementation when necessary
Performs follow up audits to ensure monitors are implemented and effective
Analyzes studies that have been prepared by government and professional associations to assess risk and opportunity for assigned departments
Identifies compliance benchmarks for assigned areas and performs analysis for risk assessment
Collaborates with System Directors and/or administration regularly to ensure awareness of any regulation changes impacting their departments.
Researches and assists Compliance Director, RGHS management and administration with new business growth for the system
Approves and collaborates with system management and administration on margin improvement initiatives, often times providing the training to staff involved in implementing, to ensure compliance
Acts as Subject Matter Expert in the continued building and optimization of the systems EMR in areas of clinical documentation, work flows and impacts on the revenue cycle to ensure compliance Performs presentations for clinicians on appropriate documentation in the EMR
Researches and assists Compliance Director, RGHS management and administration with new business growth for the system
Designs and implements training to ensure compliance of the revenue cycle focusing on clinical documentation, coding, charging, billing and denial appeals for physicians, health care providers, HIM coders and other applicable RGHS employees
Performs and manages internal investigations into reports of non compliance (fraud, waste and abuse) by RGHS employees or external sources as directed
Interviews system management and staff with respect and professionalism
Completes report and investigation in a timely manner
Reports findings to Compliance Director and follows through as directed; including assisting HR with information and interviews to ensure appropriate discipline of employees
Performs cause analysis of non compliance
Facilitates corrective action and monitors in affected departments with management
Performs follow up audits in timely manner to ensure compliance
Facilitates and manages under the general direction of Compliance Director external investigations into the system by agencies such as OIG, DOJ, OMIG, FBI, Medicare and Third Party payer fraud units. Represents the system in a positive and professional manner when communicating with agencies.
MINIMUM QUALIFICATIONS
AAS or BS in Health Information Management, Health Care Administration, Finance, or Accounting, and experience with healthcare compliance
Minimum five years of healthcare experience that includes a minimum of 3 years health care compliance experience
A combination of healthcare work experience, credentials and/or education will be considered
RHIT, RHIA, CCS, or CCS-P (Compliance Board Certification a plus)
Relevant health care related certification with experience may be considered in lieu of above certifications
EDUCATION:
LICENSES / CERTIFICATIONS:
PHYSICAL REQUIREMENTS:
Sedentary - Sedentary roles are primarily office-based and require prolonged sitting (67–100% of the workday) with minimal physical effort and lifting limited to under 10 lbs. Fine motor skills are necessary for computer work, writing, and telephone use, supported by clear visual and auditory ability. Cognitive and emotional demands are high due to extended concentration, frequent interruptions, independent decision-making, and information processing. Although physical exposure is low, administrative areas within healthcare environments may occasionally involve contact with infectious agents. Some roles may require flexible hours, TB screening, or a valid driver’s license.For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.
Any physical requirements reported by a prospective employee and/or employee’s physician or delegate will be considered for accommodations.
PAY RANGE:
$66,000.00 - $85,000.00CITY:
RochesterPOSTAL CODE:
14617The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.
Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.
Originally posted on Himalayas
Who can apply
Eligible countries: United States. Accepted UTC offsets: UTC-10, UTC-9, UTC-8, UTC-7, UTC-6, UTC-5, UTC+14. Review the full description for employer-specific work authorization, residency and schedule requirements.