What are the responsibilities and job description for the Senior Compliance Audit Analyst position at Corewell Health?
Job Summary
Responsible for implementing and maintaining program standards and work plans for assigned financial compliance program. May assist leadership or lead in development of new program or standard work opportunities. Leads more complex compliance audits and investigations, ensuring complete resolution. Supports the management of compliance standards, laws, rules and regulations. Provides advice, guidance and recommendations to minimize risk. Identifies root causes, trends/themes and assures plans and standards are in place including development, education and implementation of related procedures and policies. Maintains expert knowledge in program focused area(s), including compliance policies, procedures, issues, and industry trends. Handles the more complex level of investigations, inquiries, research and projects. Acts as a mentor to less experienced compliance team members.
Essential Functions
- Leads complex audits and investigations of compliance help line calls or other compliance contacts or reports, at the direction of management, and works with compliance leadership to determine the appropriate handling of such issues. Performs necessary research - often using specialized expertise, documents findings, and follows up with applicable parties through complete resolution. Collects, collates, and monitors audits data and activities to assure accuracy and to prevent, detect and correct non-compliance, illegal activities, and potential or actual fraud, waste or abuse. Works with outside consultants or external regulatory agencies performing audits as necessary, under the direction of CCO, director, and/or manager. From time to time, performs investigations at the direction of legal counsel and works with legal counsel in the course of such investigation to provide guidance, recommendations and other assistance as requested by legal counsel. In such cases, the employee will report directly to legal counsel as opposed to employee’s up-line leadership, and such work with legal counsel shall be confidential and protected from disclosure by the attorney client privilege and work product protection.Prepares, enters, maintains, and reconciles data in the accounts payable system. Assists in training new team members. Provides guidance and direction to less experienced Compliance professionals.
- Assists in the risk assessment and annual work plan activities. Assumes accountability for the implementation of the work plans, ensuring achievement of measurable goals, objectives and corrective action plans for assigned program area. Assists the manager and program lead in the development of standard work for auditing, investigations and corrective action and other departmental policies and procedures specific to assigned program area. Provides guidance to all compliance professionals and other key stakeholders on these processes. Uses risk-based methodologies, tools (CRA), and historical/current trends to assist in risk assessment processes.
- On a continuous basis, exercises administrative judgment and assumes responsibility for decisions, consequences and results having an impact on people, costs, and quality of service. Assists with the development, implementation and maintenance of process improvement including departmental and/or organizational policies, procedures and methodologies - assuring compliance with laws and regulations while using accumulated data. Reviews and monitors adherence to documented plans and programs including the Code of Excellence.
- Receives consultations and conducts analysis. Provides recommendation(s) to Compliance Officers and Relationship Management Teams. Collaborates with Compliance Relationship Management Teams, operational and other areas in investigations (such as HR) and to implement ongoing risk identification and mitigation measures. Proactively consults with Compliance Relationship Management Teams, operational areas and leadership through both formal (meetings, education) and informal means. Plans, coordinates and executes effective monitoring and auditing plans to reduce non-compliance.
- Maintains knowledge of complex laws and regulations impacting healthcare and health insurance delivery and reimbursement. Applies laws and regulations in daily situations while educating others through various means including formal training and annual compliance related education programs. Performs related assessments to assure compliance to laws, regulations and policies and procedures.
- Performs/leads/assists with more complex routine and for-cause financial compliance audits. Evaluates the accuracy of the regulatory standards, ICD/CPT/HCPCS and other party-payor requirements. Verifies adequacy of documentation in support of services billed, including medical necessity, and compliance with other documentation, coding and billing standards.
- Creates clear and accurate audit findings and recommendations in written audit reports that will be used for advising and educating coders/revenue cycle operations, providers, operational leaders, and other key stakeholders throughout the system. Able to maintain productivity standards. Maintains electronic record of audits, issues and investigations utilizing department tools and systems.
- .Manages a variety of projects related to regulatory financial compliance. Identifies best practices and research and evaluates its implementation within our organization. Develops recommendations and action plans. Maintains attention to detail, documents details appropriately, and effectively articulates recommendations.
Qualifications
- Required Bachelor's Degree Business, health care operations, nursing or other related area; or equivalent
- Preferred Master's Degree Business, health care operations, nursing or other related area; or equivalent
- 5 years of relevant experience Progressively responsible related work experience Required
- Health care operations, auditing and/or compliance Required
- Legal or regulatory field; healthcare focus desirable Preferred
- Compliance auditor, nurse auditor, or other audit function Required
- Project management/program development and implementation Preferred
- ICD-9 or ICD-10 and CPT 4 coding or medical record audit and review (facility and/or professional) Required
- Education of clinical and non-clinical staff including Medical Staff and mid-level providers Preferred
- Conducting investigations, performing interviews and summarizing results and findings Preferred
- CRT-Professional Coder - AAPC American Academy of Professional Coders Upon Hire required Or
- CRT-Coding Specialist (CCS) - AHIMA American Health Information Management Association Upon Hire required Or
- CRT-Coding Specialist, Certified-Physician Based (CCS-P) - AHIMA American Health Information Management Association Upon Hire required Or
- CRT-Registered Health Information Administrator (RHIA) - AHIMA American Health Information Management Association Upon Hire required Or
- CRT-Healthcare Research Compliance, Certified (CHRC) - HCCA Health Care Compliance Association Upon Hire required
- CRT-Registered Health Information Technician (RHIT) - AHIMA American Health Information Management Association Upon Hire preferred
- CRT-Healthcare Compliance, Certified (CHC) - HCCA Health Care Compliance Association Upon Hire preferred
Physical Demands
- Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 10 lbs
- Waist to Waist > 5 lbs: Seldom up to 10 lbs
- Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs
- Waist to Overhead > 5 lbs: Seldom up to 10 lbs
- Bilateral Carry > 5 lbs: Seldom up to 10 lbs
- Unilateral Carry > 5 lbs: Seldom up to 10 lbs
- Pushing Force > 5 lbs: Seldom up to 20 lbs
- Pulling Force > 5 lbs: Seldom up to 15 lbs
- Sitting: Frequently
- Standing: Occasionally
- Walking: Occasionally
- Forward Bend - Standing: Seldom
- Forward Bend - Sitting: Occasionally
- Trunk Rotation - Standing: Seldom
- Trunk Rotation - Sitting: Occasionally
- Squat: Seldom
- Stair Climbing: Seldom
- Reach - Above Shoulder: Seldom
- Reach - at Shoulder or Below: Seldom
- Handling: Occasionally
- Forceful Grip > 5 lbs: Seldom
- Forceful Pinch > 2 lbs: Seldom
- Finger/Hand Dexterity: Frequently
- Visual Acuity ¹ [None = No; Seldom = Yes]: Seldom
Primary Location
SITE - 320 Michigan St - Grand RapidsDepartment Name
System ComplianceEmployment Type
Full timeShift
Day (United States of America)Weekly Scheduled Hours
40Hours of Work
8:00 a.m. - 5:00 p.m.Days Worked
Monday to FridayWeekend Frequency
N/ACURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
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