Job DescriptionJob DescriptionAs one of Northwell's Corporate Compliance Director of Audit, you will be assigned responsibility to oversee the daily operations of the audit department within Compliance. This is a hybrid position, requiring 2-3 days in the office setting. The Audit Director will manage, plan, organize and evaluate the staff and activities associated with Corporate Compliance Audit including, but not limited to identifying areas of compliance risk and executing the annual audit work plan related to health system facilities and faculty. Job Responsibility
- Leads a Compliance group by communicating with and developing staff members, and building consensus for programs and goals that support a business, function or geographic area.
- Develops and articulates a short-term strategic vision for areas of responsibility.
- Oversees coordination, performance, education, and reporting related to compliance internal audits. Performs annual compliance risk assessments to generate annual compliance plans and repairs annual audit timeline.
- Develops compliance auditing and monitoring policies and procedures; prepares the audit status summary reports for presentation to the committee.
- Collaborates with management and other appropriate personnel involved with release of protected health information to ensure coordination and cooperation under the health system's administrative policies and procedures and legal requirements.
- Assists in investigating reports of billing non-compliance.
- Oversees and promotes the system-wide compliance coding standards.
- Monitors and audits established regulations, policies and procedures, including communication processes, self-assessments, and coding practices to ensure compliance standards.
- Provides support to coding staff and all personnel involved in coding and billing at each facility regarding coding compliance activities.
- Oversees the development and implementation of education and training programs to support coding compliance based on an assessment of the results of compliance audits and self-assessments.
- Collaborates with Internal audit, coding compliance, and research compliance to minimize overlap in compliance activities.
- Quality Assurance for all audit work including, but not limited to billing claims detail, coding, and medical record documentation to determine compliance with appropriate ICD-10-CM, ICD-10-PCS, CPT and state and federal regulations and guidelines.
- Researches, interprets and communicates federal and state laws and guidelines pertaining to Medicare and New York State Medicaid to audit report owners.
- Completes audit planning and implements compliance audits, independently.
- Manages and conducts audits in response to internal organization coding and billing compliance investigations and Helpline inquiries.
- Conducts analysis of billing/financial data resulting in the identification of potential compliance related risks within the organization.
- Collaboration with other Coding/Audit staff within the organization regarding various areas of organizational risk on both the facility and professional platforms.
- Tracking data as required by OMIG for audit education.
- Benchmarking /tracking of PEPPER Reports for Acute Care, Hospice, SNF & Partial Hospital facilities throughout Northwell.
- Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act. Duties not mentioned here, but considered related are not essential functions.
Job Qualification
- Bachelor's Degree required, or equivalent combination of education and related experience.
- 8-12 years of relevant experience and 7+ years of leadership / management experience, required.
- Minimum of ten (10) years coding experience including hospital and/or professional coding, strongly preferred.
- Experience in a large academic health system environment, preferred.
- Strong project management skills, preferred.
- Certification in one or more of the following is required, AHIMA Certification is preferred:
- Certified Coding Specialist (CCS)
- Certified Coding Specialist - Physician (CCS-P)
- Registered Health Information Administrator (RHIA)
- Registered Health Information Technician (RHIT)
- Certified Professional Coder (CPC)
- Certified in Healthcare Compliance (CHC) a plus.
- Current knowledge of regulatory requirements, hospital and physician practice guidelines as established by all applicable regulatory bodies.
- Strong conceptual, organizational, communication, interpersonal, analytical skills and an exceptional attention to detail required.
- Ability to work independently, lead staff, solve problems and communicate effectively with all levels of staff.
- Ability to read and interpret regulations and implement appropriate risk assessment methodologies and audits.
- Proficiency in Microsoft Office applications.
- Knowledge of GECB, Allscripts, Sunrise, and EPIC Systems preferred.
*Additional Salary DetailThe salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future.When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).