Revenue Cycle Compliance Auditor performs auditing activities to assess compliance of federal and state laws related to revenue cycle functions and applicable to CHRISTUS Health, including billing regulations and National and Local Coverage Determinations, as well as revenue cycle internal policies and/or industry standards. The Auditor conducts revenue cycle audits and prepares associated reports. The Auditor works in conjunction with and under direction of Director, Compliance Audit on revenue cycle compliance work plans, staff education, internal and external (e.g., OIG, CMS, etc.) audits and reviews, and provides assurance that the organization is operating in an efficient and effective manner.
Performs revenue cycle compliance audits according to the established work plan and ad hoc audits as needed, coordinates with the CHRISTUS Regional teams and the System Office as it relates to such audits, and prepares deliverables related to audit results including corrective action plans agreed to by revenue cycle leadership.
Coordinates targeted internal medical record and claim reviews with the CHRISTUS revenue cycle departments.
Identifies risks related to the revenue cycle and assists with developing annual work plan to address those identified risks.
Participates in regular compliance / revenue cycle workgroups and presents summary of compliance audit activities to the committee.
Provides subject matter expertise / education to the Revenue Cycle and other staff as directed by the Director, Compliance Audit.
Provides results of audits and education to HIM, Revenue Cycle Departments, physicians, hospital and clinic operations regarding revenue cycle requirement in conjunction with the Director, Compliance Audit.
Manages internal audit activities pertaining to compliance and coordinates with Corporate Compliance staff as it relates to such audits
Collaborates with Regional Compliance Officer on external audits and reviews, which are initiated by government agencies or government-contracted organizations
Coordinates timely medical record and claims reviews across CHRISTUS Health departments (HIM, Case Mgt., PFS)
Works jointly with Regional Compliance Officer on the compliance work plan, risk assessments, and quarterly Board Compliance reports
Serves as a member of the regional compliance committee
Provides feedback to HIM, Case Management, Patient Financial Services (PFS), Revenue Cycle, physicians and Hospital and Clinic operations regarding charging, documentation, patient status and coding issues so 'process improvement' changes are made
Conducts follow-up audits of 'process improvement' changes.
Works with CHRISTUS System office on communicating compliance/audit activities and outcomes.
Assists Compliance Officer on OIG and other government audits/reviews and other compliance-related work, as assigned. Additional work may also include diversion audits (in support of Risk Management).
Maintains confidentiality and discretion regarding all work matters and works cooperatively with all team members and demonstrates competence to perform assigned responsibilities is a manner that meets the population-specific and developmental needs of the members served by the department.
Appropriately adapts assigned assessment, treatment, and/or service methods to accommodate the unique physical, psychosocial, cultural, age-specific and other developmental needs of each member served.
Takes personal responsibility to ensure compliance with all policies, procedures and standards as promulgated by state and federal agencies, the hospital, and other regulatory entities.
Performs all duties in a manner that protects the confidentiality of patients and does not solicit or disclose any confidential information unless it is necessary in the performance of assigned job duties.
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.