Performs objective audits and/or reviews of Health Ministries (HM) in support of an effective compliance program. As a technical resource, serves the HMs for questions related to health record documentation, coding, billing, and general regulatory compliance. Works on special compliance related projects, assists in disseminating information and providing education to the HM and System Office departments while also assisting with the development of audit tools, job aids and educational programs used to maintain compliance with regulations.ESSENTIAL FUNCTIONS
Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
Maintains a high level of knowledge of healthcare accreditation standards along with applicable federal, state and local laws and regulations specific to the healthcare service line for which the individual is responsible for reviewing/auditing. Conducts research, can assemble and/or disseminate regulatory information, coding guidelines, or other official information that supports decisions.
Plans, prepares and regularly conducts audits/reviews and other compliance related projects within an area of expertise relative to a specific healthcare service line, under the supervision of the I & C Manager. Works closely with external consultants (when applicable) in performing similar audits. Reports timely on compliance issues detected through audits/reviews and compliance monitoring to their I&C Manager.
Assists the I&C Manager in completing all aspects of project audit programs, consistent with IIA standards, from opening to closing procedures, including writing reports that document the findings from audits/reviews
Collaborates with their I&C Manger, serving as a technical resource for documentation, coding and billing regulations across Trinity Health for service line(s) assigned. Duties may include teamwork in cross functional teams and consulting with System Office departments such as Revenue Excellence, TIS, Legal, Finance or others as needed.
Assists in the development of audit tools (e.g., checklists, job aids, presentations, ICP Alerts) and utilizes those tools to analyze, trend, and identify variations to established procedures and compliance with rules and regulations.
Participates in the preparation and development of compliance related educational sessions and presents those sessions in collaboration with the I&C Manager. Other duties as needed and assigned by the manager.
Maintains a working knowledge of applicable Federal, State, and local laws/regulations, the Trinity Health’s Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior.
MINIMUM QUALIFICATIONS
1. Must possess at least one of the following licenses/certifications: CPC, CCS-P, RHIT, RHIA, RN, PT, OT or professional certification in another healthcare field (as appropriate for the subject matter assigned to audit) as normally obtained through a degree program or an equivalent knowledge base and a minimum of three (3) years’ experience in a health care setting. The minimum of an Associate’s Degree is required, Bachelors preferred.
2. Additional coding certification through either AHIMA or AAPC or equivalent knowledge base is preferred.
3. Must have an in-depth knowledge of Medicare and Medicaid documentation, coding, and billing regulations for applicable service lines(s) assigned, in addition to CMS Conditions of Participation. Additional knowledge of other third-party payer requirements for documentation, coding and billing preferred.
4. Must exhibit behaviors that contribute toward a collaborative, supportive, shared leadership environment
Hourly payrate: $26.87 - $40.32
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.