The Office of Compliance and Corporate Integrity (OCCI) is seeking a Compliance Audit Consultant experienced in the review and monitoring of health care systems and processes relating to documentation, coding, billing and contracting. This position will consult with designated service areas within VUMC as they respond to questions and evolve processes, and partner with technical functions, such as contracting personnel, billing managers, medical coders to establish best practices and develop and maintain practice pathways to adhere to VUMC policy. This position will also perform directed audits and recurring monitoring consistent with OCCI work plans and processes. These audits will be designed to assess adherence to VUMC policy and increase understanding of best practices and foster a reduction in performance variance.
The OCCI is responsible for ensuring that the clinical enterprise implements and maintains an effective compliance program that includes:
• Written standards of conduct and policy
• A dedicated Compliance Officer and oversight Committee
• Regular training of employees
• A process to receive complaints, respond to allegations and remedy problems
• Audits to monitor compliance
• A process to investigate identified concerns
- Enforcing disciplinary standards
The Compliance Audit Consultant will be a vital member of the Auditing and Monitoring Team within OCCI.
- Data and Trending Analysis. Perform analyses of data from internal and external sources to assess potential areas of risk to VUMC.
- Work and Audit Plans. Prepare clear, concise and meaningful audit plans that identify the scope, universe and level of effort warranted for each review.
- Auditing and Monitoring. Perform independents audit and reviews of contracts, systems, processes, documentation and billing. Draft reports to present results to individuals from a broad spectrum of departments and disciplines with VUMC. Retain appropriate documentation supporting process, methodology, and results for each review. .
- Knowledge and Research. Maintain current knowledge of VUMC policy and regulatory standard, and participate in research of technical questions to gather information for appropriate resolution of issues.
- Compliance Efforts. Assist as requested with the general compliance program initiatives of OCCI within VUMC.
- Collaboration. Team with OCCI and VUMC leaders to support timely and consistent application of standards between services areas and all support functions.
We look forward to receiving your online profile/CV. Interviews are tentatively scheduled for February 2014.
- Associates Degree required; Bachelor's degree strongly preferred
- Certification in relevant healthcare auditing (AHIA) , coding (AAPC or AHIMA), or systems analysis (HIMSS) is preferred.
- 3 years' related experience required
- Clinical degree or experience in compliance related disciplines preferred
- Strong computer skills with competency in Microsoft Word, Access and Excel
- Familiarity with using technology to extract data and reports from internal and external databases to perform benchmark analyses and identify potential outliers and anomalies
- Familiarity with electronic medical records systems, MGMA data, UHC data and/or VUMC Business Objects reporting preferred
- Industry and content expertise in integrated billing compliance, regulatory affairs, privacy/security, audit, and business/physician transaction regulatory compliance
- Experience with process and/or quality improvement initiatives preferred
- Demonstrated experience in internal audit principles and practices.
- Knowledge of federal regulations, healthcare program billing requirements and privacy/security standards. Proven record of successful experience in the application of these mandates in a multi-functional, multi-disciplinary setting
- Competence in preparing and presenting audit results to individuals at a variety of levels from various constituencies within the organization
Job Medical Coding and Billing
Primary Location TN-Nashville-Office of Compliance & Corporate Integrity
Organization Compliance & Corp Integrity 108715