Compliance Audit Specialist

Position Details

Department: PCH-MAIN | Corporate Compliance
Category: Legal/Risk/Reg Compliance
Location: Phoenix
Employee Type: Regular
Posting #: 426668
Posted On: 12/6/2018

Position Summary

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.

Position Duties

  1. 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.
  2. 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.
  3. Performs miscellaneous job related duties as requested.

Phoenix Children's Mission, Vision, & Values

Mission

To advance hope, healing and the best healthcare for children and their families

Vision

Phoenix Children's will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education.

We realize this vision by:

  • Offering the most comprehensive care across ages, communities and specialties
  • Investing in innovative research, including emerging treatments, tools and technologies
  • Advancing education and training to shape the next generation of clinical leaders
  • Advocating for the health and well-being of children and families
Values
  • We place children and families at the center of all we do
  • We deliver exceptional care, every day and in every way
  • We collaborate with colleagues, partners and communities to amplify our impact
  • We set the standards of pediatric healthcare today, and innovate for the future
  • We are accountable for making the highest quality care accessible and affordable
The position has been closed or filled.

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