Job description

Duke University Health System

Supervisory Responsibility: No

FLSA: Exempt

Market Target: G1

Job Code: 5119

General Description of the Job ClassConduct health-system wide compliance audits to ensure data integrity, compliance with federal and state regulations pertaining to but not limited to: federal healthcare program requirements, coding and documentation and clinical trials billing. Interpretation of applicable federal and state law & regulations to plan audit parameters, determine department’s compliance with such regulations and communicate to department necessary changes in compliance with regulatory requirements. As well as, manage health system wide response to governmental audits to ensure data integrity and completeness of records and accuracy of claims.

Duties and Responsibilities of this Level:

- Responsible for conducting compliance audits, documenting & communicating findings and recommendations, explaining regulatory requirements, and overseeing the corrective actions for audits within DUHS

- Manage activities related to monitoring requests and responses of governmental audits (e.g. RAC and Medicaid Program Integrity), monitor and trend activity, and oversee and monitor appeals.

- Conduct risk assessments and preparation of work plans.

- Develop an understanding of the operations, system processes and procedures used in areas being audited.

- Review and test for compliance with institutional policies and procedures, applicable laws and regulations through the inspection of physical operations, processes, retrieval and review of documents and investigation of irregularities and errors.

- Compile information and/or prepare reports and analyses setting forth results of compliance audits with appropriate recommendations; perform subsequent audits to ensure complete and appropriate corrective action.

- Develop recommended corrective actions to address issues detected.

- Actively participates in exit conferences, providing clarification and supporting information necessary.

- Performs other related duties incidental to work described above

Required Qualifications at this Level

Education: Work requires a general business background generally equivalent to a Bachelor's degree in a business administration, accounting, management, healthcare administration, other related degree.

Experience: Four years of experience related to legal, regulatory compliance, patient advocacy, supervisory role in patient financial services or HIM services, or other relevant experience.

Degrees, Licensure, and/or Certification: N/A

Knowledge, Skills, and Abilities: Knowledge of billing compliance, knowledge of Medicare/Medicaid regulations, including billing, coding and documentation requirements. Coding certification (e.g. CPC, CCS, RHIA, RHIT) or applicable experience is preferred.

In depth knowledge of federal regulations

Strong oral and written communication skills.

Distinguishing Characteristics of this Level


Job Level: G1

Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secureand welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.




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Job No:
Posted: 2/20/2021
Application Due: 5/21/2021
Work Type: Full Time