Search for Jobs

1 Result for "Yale New Haven Health"
Yale New Haven Health
New Haven, CT, United States (hybrid)
12 days ago
Yale New Haven Health
New Haven, Connecticut, United States (hybrid)
12 days ago

Description

Overview

Reports to the Revenue Compliance Audit & Education Program Director. This position assists in the planning, organizing, and completion of revenue compliance auditing and education activities required to comply with federal guidelines and other compliance -related requirements. To identify lost revenue opportunities and any overpayments made due to errors in coding, insufficient medical record documentation, etc. To increase and strengthen health care providers' awareness and understanding of medical record documentation guidelines and coding principles. Serves as a role model for ethical management behavior and promotes an awareness and understanding of the System's Code of Conduct and Privacy and Corporate Compliance Program. Assists the Program Director in assessing risk and developing an auditing plan to support the overall compliance plan. Interacts with all levels of management within the Health System.

Responsibilities

1. Monitors audit activities being conducted by government payors, auditors and other healthcare systems in order to incorporate these areas into the OPCC audit program as appropriate and to be able to respond to these inquiries.

2. Assists the Revenue Compliance Audit/Education Program Director in:

  • 2.1 Performing risk analyses to identify areas with greatest potential for non-compliance with governmental and internal requirements.

3. Performs audits (both scheduled and ad hoc) and assists in coordinating revenue compliance auditing of services provided to or by Yale New Haven Health System (YNHHS). This includes all billing and coding activities for the System including hospital, professional, skilled nursing, and any other services.

4. Works with YNHHS leadership to perform comprehensive compliance audits as designed and directed via the Program Director and the Annual Compliance Work Plan. Maintains documentation of methods used and individuals involved in verifying compliance; documented identified issues, corrective actions taken, and improvements implemented. Establishes and implements best practices for audit working paper documentation, security, and retention.

5. Schedules meetings with appropriate management to discuss audit initiation. Consults with senior management and staff upon the conclusion of audits, both orally and in writing, to describe observations and recommend corrective action which will enhance compliance.

6. Assists in the development of the audit scope and objectives. Creates final audit reports for review by the Program Director and the Compliance & Privacy Officers.

7. Develops policies and procedures for auditing medical records for compliance with required documentation guidelines including completeness and accuracy of coding. Makes recommendations which are consistent with regulatory requirements for coding/ documentation, to assure that services rendered are documented and bills are submitted appropriately as an integral part of YNHHS's overall Compliance Program.

8. Oversees focused, technical education for coders, physicians and other clinical staff to promote knowledge regarding medical record documentation guidelines, billing rules and related standards.

9. Regularly assists in the development and presentation of programs to staff to accomplish educational objectives as set forth in the Compliance Program

10. Participates in charge master reviews and other coding reviews, coordinating follow up.

11. Assists in the retrieval of data to assist department directors/managers in accomplishing the objectives of compliance, as may be necessary.

12. Works with external auditors, hired as independent contractors, to pull audit data and to finalize audit finding reports.

13. Demonstrates a knowledge and understanding of organizational policies and procedures, billing and reimbursement requirements and other regulations that affect operations. Maintains a library of appropriate reference material that will facilitate the understanding and compliance of federal coding/documentation requirements.

14. Participates in healthcare compliance professional groups in order to stay abreast of corporate compliance developments and best practices within the industry.

15. Provides research and advice for revenue compliance issues that are raised with the OPCC.

16. Represents the OPCC by participating in committees and workgroups as requested.

17. Ensures confidentiality of all audit reports generated by this department, working within established policies for protecting data.

18. Works collaboratively with Internal Audit, Finance, and other appropriate departments both in identifying the workplan each year and works to effectively communicate audit results with these parties.

19. Performs in a professional manner, exercising independent judgment and ethical standards at all times.

20. Interacts with employees at all levels, demonstrating impartiality and fairness.

21. Strives to continually improve the YNHHS Compliance Program.

22. Performs similar or related duties as assigned or directed.



Requirements

EDUCATION

Bachelor's degree in Accounting, Business Administration or Healthcare Administration. Certification in coding is required.

EXPERIENCE

Minimum of five (5) years experience in revenue compliance auditing, performing medical record audits for clinical documentation, charge and reimbursement accuracy. Experience in hospital and provider coding with CPT and ICD-9-CM. Knowledge of health care management in terms of financial and billing concepts. Knowledge of health care reimbursement and managed care issues.

LICENSURE

CCS, CCS-P, CPC, CPC-H, RHIA or RHIT is required

Job Information

  • Job ID: 65816089
  • Workplace Type: Hybrid
  • Location:
    New Haven, Connecticut, United States
  • Company Name For Job: Yale New Haven Health
  • Position Title: Professional Revenue Compliance Auditor
  • Setting: Hospital
  • Job Function: Revenue Cycle Management
  • Job Type: Full-Time
  • Min Education: Bachelors
  • Min Experience: 5-7

Please refer to the company's website or job descriptions to learn more about them.

View Full Profile

Jobs You May Like
Filters
Workplace Type
Job Function
Setting
State