• Clinical Compliance Internal Auditor, Clinical License Preferred

    Job Locations US-NJ-Monmouth County
    Posted Date 4 weeks ago(6/27/2018 10:30 AM)
    ID
    2018-3765
    # of Openings
    1
    Type
    Regular Full-Time
    Category
    Compliance
  • Overview

    The Compliance Auditor will report to the Corporate Compliance Officer and assist with developing, managing, implementing, auditing and monitoring activities. Will provide training to VNAHG staff to assure compliance, as described in the annual compliance work plan. Strong analytical and communication skills required to ensure service lines and business areas have processes and guidelines in place to comply with applicable State and Federal laws and regulations for Medicare and Medicaid, and other third party insurers. Business areas will include, but are not limited to: eligibility, access center, billing, OASIS, coding, clinical documentation and medical records. Independent monitoring in analyzing risk assessments, performing audits, creating reports and scorecards, educating and following up with agencies to ensure processes exist that demonstrate compliance with applicable State and Federal laws, regulations, policies and procedures.

     

    Responsibilities

    • Manages daily operation of the compliance audit program (including audit, review, data analysis and staff training initiatives) and regularly reports to the Corporate Compliance Officer on the status of the program.
    • Coordinate internal and external audits, appeals, compliance scorecards, reviews and investigations of home health, hospice and other business lines.
    • Manages and coordinates State and Federal audits, such as CMS audits and other Third Party audits
    • Analyzes audit findings, reports and assessments and provides recommendations for corrective action plans.
    • Assists the Corporate Compliance Officer to develop scorecards, and maintains data to track and display key audit areas for each service line.
    • Monitor components of admissions, re-certifications and resumptions of care for quality, accuracy and timeliness utilizing standardized audit tools. Review clinical information for appropriateness in home health, hospice and other service lines.
    • Work collaboratively with access center, managers, OASIS reviewers, coders, quality, IT, medical records and revenue cycle departments and makes appropriate recommendations to procedures and guidelines to ensure compliance with stated regulations.
    • Provide education and training for staff to ensure quality, accuracy and timeliness of documentation and billing.
    • Maintain a working knowledge of rules and regulations, including HIPAA/ HITECH privacy laws that impact home health, hospice and other service lines.
    • Assist the Compliance Officer in reviews and investigations of compliance issues or concerns within the organization to appropriately evaluate and resolve in a timely manner.

     

    Qualifications

     

    • Bachelors required/ Masters preferred in Nursing or Physical Therapy
    • Five + years of clinical experience; home care, hospice experience strongly preferred.
    • Two + years Quality/Compliance clinical documentation and/or internal audit experience
    • OASIS certification strongly preferred; ICD-10 Coding or Professional Medical Auditor Certification preferred
    • Knowledge of tools and techniques used to conduct audits, research, analysis and evaluations
    • Thorough knowledge of the home health, hospice and physician revenue cycle and billing process
    • Working knowledge of state and federal regulations, Medicare and Medicaid and third party payer requirements
    • Advanced computer skills with proficiency in Excel, Word, data analytics software; HomeCare HomeBase EMR experience a plus
    • Must have ability to analyze data and make data-driven strategic decisions
    • Excellent organizational and training skills
    • Excellent verbal and written communication skills
    • Must possess excellent interpersonal relationship skills
    • May be required to travel outside of State to business locations as needed.

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