Manager, Compliance Audit & Analyst

Overview

Be inspired. Be rewarded. Belong. At Emory Healthcare.

 

At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide:

• Comprehensive health benefits that start day 1 • Student Loan Repayment Assistance & Reimbursement Programs • Family-focused benefits • Wellness incentives • Ongoing mentorship, development, and leadership programs • And more Work Location: Atlanta, GA

Description

• Reporting to the Director, Compliance Audit and Analysis, oversees audits, monitoring, and education for hospital and professional billing, coding and documentation programs that confirm compliance, identify reimbursement implications, and provides billing providers with relevant and timely information regarding audit results and risk areas.
• Evaluates hospital and professional billing compliance activities to assess compliance and appropriate focus on risk areas.
• Implements policies, strategies, and workflows to ensure accurate medical record documentation, professional billing and coding compliance.
• Serves as a resource for the organization regarding coding and billing compliance, including conducting research as needed to help the organization achieve compliance.

 

Principal duties and responsibilities:

• Formulates, reviews, and updates EHC compliance policies related to billing and coding.
• Communicates applicable policies and procedures to the enterprise as needed. 
• Prepares and oversees billing and coding components of the Compliance work plan reflecting scheduled activities and target dates. 
• Leads focused audits and reviews to investigate adherence with billing compliance policies, legal and regulatory requirements, and to identify and evaluate risk areas.
• Assists in development of organizational compliance auditing and monitoring activities for billing and coding, including periodic reviews of the individual department auditing and monitoring functions. 
• Coordinates sample reviews to ensure codes that were billed are properly supported by appropriate documentation.
• Creates audit result reports to be reviewed with departments and providers, as applicable. 
• Leads education sessions with departments, coders and/or providers, as applicable, to review audit results. 
• Conducts sample and focused reviews to ensure coding and billing is compliant with government and payor guidelines.
• Analyzes and reviews medical record documentation and billing data for all pertinent internal and external audits, in collaboration with Revenue Cycle as appropriate. 
• Works collaboratively with clinical and administrative departments throughout the organization to further the organizations objectives and serve as an advisor regarding coding and billing compliance risks.
• Supports compliance education initiatives, including overseeing the development and delivery of coding and billing compliance educational programs to address existing and emerging Federal and State requirements 
• Manages and fosters relationships with internal clinicians and coders and third-party clinical reviewers. 
• Assists with provision of counseling, education and/or recommendations for disciplinary action if necessary or required for non-compliance with any internal or external policies and procedures related to billing compliance.
• Implements and maintains a system of management reporting that provides timely and relevant information on all aspects of billing auditing and monitoring and related compliance issues.
• When appropriate, manages staff who may be conducting focused coding and billing compliance audits and/or other special projects included in the annual departmental work plan.
• Maintains required credentials, participates in continuing education opportunities to remain current with billing and coding compliance best practices (i.e., conferences, workshops, and other professional development activities).
• Actively participates in system wide management activities, attends meetings and in-service/educational programs and other activities as requested.

 

Education and experience requirements: 

• Bachelors degree required. 
• Clinical background preferred (i.e., LPN, RN, etc.). 
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) credentials required.
• Certification in Health Care Compliance preferred. 
• Minimum of five (5) years of experience with audit activities required. 
• Minimum of three (3) years