Compliance Auditor - CBO Compliance - Full Time - Days
- Req #: 11233
- Address: 2100 Sherman Ave
- City, State: Norwood, OH
- Zip: 45212
- Type: Full time
- Shift: Day
Job Description
The Compliance Auditor is responsible for carrying out and implementing The Christ Hospital Health Network's ("TCHHN") Division of Compliance and Organizational Ethics (the "Division") System audit and education programs. The Compliance Auditor follows policies and procedures that promote the goals of the Division and facilitates effective audits, monitors and reporting to management. The Compliance Auditor maintains superior Excel database skills to assure efficiencies in production of audits and data analysis. The Compliance Auditor performs Compliance risk assessments, evaluates processes for compliance effectiveness, designs audit test plans to review high risk processes and billing. The Compliance Auditor performs audits, investigations and reviews, making recommendations to management on internal control and process effectiveness. The Compliance Auditor maintains Compliance databases and participates in education and training of physicians and employees. The Compliance Auditor is knowledgeable of applicable regulations and communicates effectively and works collaboratively with TCHHN stakeholders to assure compliance. The Compliance Auditor will be responsible for the dissemination, implementation of policies, compliance and audit standards, and Department database maintenance.
Responsibilities
Qualifications
KNOWLEDGE AND SKILLS: Please describe any specialized knowledge or skills, which are REQUIRED to perform the position duties. Do not personalize the job description, credentials, or knowledge and skills based on the current associate. List any special education required for this position.
EDUCATION: Bachelor's degree required. Health Care cost reporting-reimbursement experience highly desired. CHC certification required after one year on the job.
YEARS OF EXPERIENCE: At least 5 years preferred; healthcare accounting/cost reporting/reimbursement experience desired.
REQUIRED SKILLS AND KNOWLEDGE: Superior, advanced knowledge of Microsoft Excel and data base mining is required at entry. Advanced knowledge of PowerPoint and Word are required. Must be able to adeptly navigate through IT software platforms used at the hospital and physician offices. Strong organizational, and communications skills, both oral and written. The ability and willingness to confront issues and negotiate, must have the ability to work effectively independently, under pressure and with strict deadlines. Knowledge of current revenue cycle compliance issues facing the hospital industry, including fraud and abuse issues resulting from interactions with healthcare professionals, and reimbursement by government payment programs. Knowledge of hospital reimbursement, the ability to exercise commensurate independent judgment and discretion in areas of responsibility is required along with the ability to accomplish multiple tasks simultaneously. Strong analytical and problem solving skills required to independent set objectives, testing standards and determine findings.
LICENSES & CERTIFICATIONS: CPA preferred. CHC certification required after one year.
About Us
For more than 130 years, The Christ Hospital been the beacon for exceptional healthcare in the Greater Cincinnati community. We're industry pioneers, always pushing the boundaries and reimagining the future of healthcare.
Our culture promotes collaboration, diversity and innovation. Together, as a team, we work tirelessly to enhance healthcare quality, accessibility and safety.
The Compliance Auditor is responsible for carrying out and implementing The Christ Hospital Health Network's ("TCHHN") Division of Compliance and Organizational Ethics (the "Division") System audit and education programs. The Compliance Auditor follows policies and procedures that promote the goals of the Division and facilitates effective audits, monitors and reporting to management. The Compliance Auditor maintains superior Excel database skills to assure efficiencies in production of audits and data analysis. The Compliance Auditor performs Compliance risk assessments, evaluates processes for compliance effectiveness, designs audit test plans to review high risk processes and billing. The Compliance Auditor performs audits, investigations and reviews, making recommendations to management on internal control and process effectiveness. The Compliance Auditor maintains Compliance databases and participates in education and training of physicians and employees. The Compliance Auditor is knowledgeable of applicable regulations and communicates effectively and works collaboratively with TCHHN stakeholders to assure compliance. The Compliance Auditor will be responsible for the dissemination, implementation of policies, compliance and audit standards, and Department database maintenance.
Responsibilities
- Implements the Compliance audits and work plan tasks, plans events and due dates. Recommends audit scope in conjunction with the Director of Compliance, and develops investigation and audit objectives in comportment with the plan. Performs audits and testing to validate internal control effectiveness. Prepares succinct and complete audit reports of findings, timely communicates findings to management and develops follow up procedures to test action plan effectiveness. Tracks data using electronic databases, and maintains organized work paper files.
- Leads privacy violation investigations and documents findings for potential regulatory reporting. Collaborates with the Privacy Officer and Management to identify and implement process improvements. Communicates regulatory standards throughout TCHHN. Represent the Privacy department in various TCHHN committees and task teams. Assists the Privacy Officer with annual breach reporting to the HHS Office of Civil Rights.
- Provides guidance to management, medical staff and employees in areas of compliance, maintains competencies in regulatory requirements, laws and standards, and maintains working knowledge of CMS website manuals and audit procedures standards, including sampling techniques, testing standards and reporting standards.
- Effectively communicates both orally and in writing with the areas that will be audited; performs a pre-conference prior to the audit and a post-conference upon completion of the audit.
- Maintains hot line and disclosure log databases, performing investigations into concerns, issuing reports and oversees follow-up with departments to assure issues are resolved /addressed.
- Actively participates in the Compliance Committee and other committees that implicate compliance risk: e.g., Utilization Review; Revenue Cycle Meetings; Management meetings.
- Maintains compliance education training databases. Notifies covered persons timely with training requirements, monitors compliance with training requirements.
- Identifies training needs and assists in the development and delivery of those training needs. Maintains online training websites and content to assure content is up to date and meets regulatory requirements.
- Performs training and education across TCHHN, including new employee orientation.
- Oversees the Division's Federal and State Exclusion Screening process.
- Assists with physician pay process including Compliance review and processing of physician timesheets through Accounts Payable and Payroll.
- Effectively manages priorities and workload and completes projects in an accurate and timely manner and performs other duties as assigned.
Qualifications
KNOWLEDGE AND SKILLS: Please describe any specialized knowledge or skills, which are REQUIRED to perform the position duties. Do not personalize the job description, credentials, or knowledge and skills based on the current associate. List any special education required for this position.
EDUCATION: Bachelor's degree required. Health Care cost reporting-reimbursement experience highly desired. CHC certification required after one year on the job.
YEARS OF EXPERIENCE: At least 5 years preferred; healthcare accounting/cost reporting/reimbursement experience desired.
REQUIRED SKILLS AND KNOWLEDGE: Superior, advanced knowledge of Microsoft Excel and data base mining is required at entry. Advanced knowledge of PowerPoint and Word are required. Must be able to adeptly navigate through IT software platforms used at the hospital and physician offices. Strong organizational, and communications skills, both oral and written. The ability and willingness to confront issues and negotiate, must have the ability to work effectively independently, under pressure and with strict deadlines. Knowledge of current revenue cycle compliance issues facing the hospital industry, including fraud and abuse issues resulting from interactions with healthcare professionals, and reimbursement by government payment programs. Knowledge of hospital reimbursement, the ability to exercise commensurate independent judgment and discretion in areas of responsibility is required along with the ability to accomplish multiple tasks simultaneously. Strong analytical and problem solving skills required to independent set objectives, testing standards and determine findings.
LICENSES & CERTIFICATIONS: CPA preferred. CHC certification required after one year.
About Us
For more than 130 years, The Christ Hospital been the beacon for exceptional healthcare in the Greater Cincinnati community. We're industry pioneers, always pushing the boundaries and reimagining the future of healthcare.
Our culture promotes collaboration, diversity and innovation. Together, as a team, we work tirelessly to enhance healthcare quality, accessibility and safety.
