Posting Note: #PCHCB
At the direction of the Compliance Manager, supports all aspects of compliance program with primary focus on billing, coding and documentation audits. This position provides training and education to the coding and medical staff. This position works with the hospital and physician revenue cycle teams to identify review and resolve coding issues related to billing. This position also assists with general compliance activities.
- Family-Centered care that focuses on the need of the child first and values the family as an important member of the care team
- Excellence in clinical care, service and communication
- Collaborative within our institution and with others who share our mission and goals
- Leadership that set the standard for pediatric health care today and innovations of the future
- Accountability to our patients, community and each other for providing the best in the most cost-effective way.
Performs compliance monitoring and auditing of billing, coding and documentation related to inpatient, outpatient surgery, observation, emergency department, urgent care and professional services for all payors.
- Performs coding and billing audits.
- Reviews external coder and provider audits/reports.
- Reviews and prepare compliance audits reports.
- Assists in the development of training materials and implementation of educational sessions.
- Assists in the preparation and response to external oversight agency and commercial payor audits, and inquiries including CMS, Medicaid (AHCCCS), RAC, HRSA, PERM, etc.
- Reviews internal processes to ensure compliance with regulatory requirements.
Miscellaneous Compliance Generalist
- Responds to identified areas of risk through investigation and internal audit.
- Maintains a compliance dashboard of all internal monitoring.
- Assists in the preparation of the annual risk survey and risk assessment.
- Assists in the preparation and execution of the annual audit plan.
- Assists in monitoring and responding to Compliance hotline reports.
- Develops and distributes the compliance newsletter.
- Assists in monitoring EHR or miscellaneous system access audits.
- Assists in monitoring and tracking Conflicts of Interest.
- Tracks compliance investigations in the compliance tracking software.
- Stays current with changing regulatory requirements through review of periodicals, compliance association newsletters, and review of state and Federal regulatory agency work plans to ensure compliance.
- Assists in the development and management of learning management systems and compliance training materials.
- Performs miscellaneous job related duties as requested.