Compliance Auditor

HCA Richmond , VA 23234

Posted 1 week ago

Henrico Doctors' Hospital is a 340-bed Level II Trauma Center offering a full range of healthcare services. We offer specialized vascular surgery, Neurosurgery, a comprehensive certified stroke center, orthopedics and groundbreaking diagnostic imaging. We're also a national trendsetter in kidney transplants through the Virginia Transplant Center and as part of the Virginia Institute of Robotic Surgery; we lead the state in minimally-invasive procedures with da Vinci robotic-assisted surgeries.

SPECIFIC ELEMENTS AND ESSENTIAL FUNCTIONS

  • Responsible for oversight for facility compliance of REGS.GEN.002 (Medicare National & Local Coverage Determination)

  • Notification/distribution/education of NCD/LCD that apply to the hospital's services, procedures and devices.

  • Establish responsibility/accountability of compliance with the NCDs/LCDs

  • Aid in establishing processes/procedures to perform medical necessity review prior to performing a service, procedure, or device & HINN/ABN are given before services are rendered.

  • Utilize trended data to identify root cause & develop education &/or assist in developing process improvement in workflow to minimize write-offs.

  • Review MSC write-off report on a monthly basis to identify education/billing opportunities for Pt Access, departmental services, Coding, & validation of NCD/LCD edit application.

  • Attend designated department meetings related to write-offs and process improvement

  • Work in conjunction with various departments to establish pricing for CFO approval.

  • Participate in all "new business" ventures to determine compliance related to Provider Based requirements, charge structure, reimbursement.

  • Perform post implementation audits to validate charge capture & documentation meet agreed upon criteria and follow reimbursement.

  • Manage the Labor and Delivery charge capture process

  • Assist with the Observation charge capture process

  • Participate in unbilled management

  • Weekly analysis of accounts on HOLD

  • Serve as liaison between RPAS/HSC staff and facility related to charge capture/documentation issues

  • Special projects as assigned by CFO/VP of Finance

REQUIRED SKILLS, KNOWLEDGE AND ABILITIES

  • Clinical background or understanding of clinical operations

  • Strong communication skills with hospital and medical staffs

  • Understanding of services, procedures and devices provided by the hospital

  • Ability to understand implications of NCDs and LCDs to hospital and hospital departments

  • Capability to summarize requirements of NCDs/LCDs for education of relevant hospital departments and staff.

  • Ability to use tools and resources pertaining to NCDs/LCDs which are available on Regs website, CMS' website, Medicare Contractor's website, etc.

  • Ability to develop and deliver hospital specific educational materials

  • Ability to manage multiple tasks and projects in a fast paced environment.

  • Strong communications skills

  • Professional in appearance and manner

  • Strong organizational skills

  • Ability to work well independently and as a group

EXPERIENCE

Required 5 years charging/auditing experience in an acute care hospital.
5 years of nursing or clinical experience in an acute care hospital setting.

EDUCATION

Required Nurse (RN/LPN), Allied Health Professional or coding certification with coding &/or charging experience


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Compliance Auditor

HCA