Job Description

Compliance Coding Specialist - Hybrid - Full time - Days at Mohawk Valley Health System summary:

The Compliance Coding Specialist oversees internal and external compliance audits within a healthcare system, ensuring adherence to regulatory guidelines and internal policies. They identify compliance risks, develop mitigation strategies, and collaborate with various departments to enhance the compliance program. The role also includes preparing audit reports, conducting training, and serving as a liaison for government claim recovery activities and audits.

Job Summary

The Internal Auditor - Compliance will oversee the internal and external compliance audits for the Mohawk Valley Health System (“MVHS”) audit and compliance function under the guidance and direction of the Chief Compliance Officer. This position will play a key role in assessing and improving the effectiveness of the compliance program across the organization. The Internal Auditor - Compliance will identify areas to be audited based on regulatory guidelines and the company’s risk areas. The Auditor will implement and monitor corrective action plans where necessary, collaborating with various departments.

Core Job Responsibilities

• Plan, execute and report on compliance audits across various functions and departments within the MVHS.
• Review and analyze processes and policies to ensure they are aligned with regulatory requirements and internal standards.
• Identify potential areas of compliance risk and assess their impact on the organization.
• Develop and implement risk assessment strategies to mitigate identified risks.
• Assist in the development, communication and enforcement of policies and procedures system wide.
• Develop and deliver compliance training based on identified audit findings.
• Prepare detailed audit reports and presentations, outlining findings, recommendations and compliance status in collaboration with the Chief Compliance Officer.
• Work closely with internal teams, including Legal, Risk Management, and operations to enhance compliance efforts.
• Monitor healthcare industry trends and changes in regulations to ensure ongoing compliance.
• Research Federal and State regulations and guidelines, communicate the requirements to various departments and assess the organization’s compliance with the requirements.
• Conduct or assist in external and internal audits and reviews. Track findings and corrective actions.
• Analyze data from audits to identify patterns, trends and variances and compile statistical analysis.
• Serves as the primary RAC and appeals liaison for the hospital, including preparation of quarterly statistical summaries on all government claim recovery activities and presents trends/findings to the Compliance Committee.
• Coordinates and maintains appropriate workflow with the Appeals team, tracking all CMS audits such as RAC, ADR, CERT.
• Conduct or assist in internal compliance investigations and reviews.
• Maintain current working knowledge of regulatory requirements associated with hospital and professional coding, billing, documentation and reporting requirements.
• Perform related duties as assigned.
  

Education/Experience Requirements

REQUIRED:

• Bachelor’s Degree in Health Information Management, Nursing, Health Care administration or a compliance-audit related field, or equivalent work experience.
• 3-4 years of experience in a health care environment.
• Must possess understanding of coding.
• Ability to interact effectively with employees, the public, senior executives and Board of Directors.
• Outstanding interpersonal, verbal and written communication and presentation skills.
• Proficiency with technology and able to learn new applications.
• Demonstrated ability to think critically, use analytical skills, and make logical decisions.
  

PREFERRED:

• Experience performing coding, documentation and billing audits.

Licensure/Certification Requirements

PREFERRED:

• RHIA, RHIT or CCS or eligible for exam with experience coding acute care inpatient and outpatient records.

Disclaimer

Qualified applicants will receive consideration for employment without regard to their age, race, religion, national origin, ethnicity, age, gender (including pregnancy, childbirth, et al), sexual orientation, gender identity or expression, protected veteran status, or disability.
Successful candidates might be required to undergo a background verification with an external vendor.

Job Details

Req Id 94358
Department LEGAL AND COMPLIANCE
Shift Days
Shift Hours Worked 8.50
FTE 1
Work Schedule SALARIED GENERAL
Employee Status A1 - Full-Time
Union Non-Union
Pay Range $67k - $87k/Annually

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Keywords:

compliance auditing, healthcare compliance, coding audits, risk assessment, regulatory compliance, internal audit, medical coding, billing audits, health information management, corrective action plans

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