Enterprise Provider Compliance Auditor-Educator; Morgantown, WV

Enterprise Provider Compliance Auditor-Educator

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The Enterprise Compliance Auditor/Educator will assist with the implementation and facilitation of ongoing compliance auditing, monitoring, and education associated with all provider services across WVUHS and its affiliates. The duties of this position will help ensure that all healthcare provider (MD/DO, APP, and other non-physician practitioners) organizations remain in compliance with all federal healthcare program rules, regulations, administrative requirements and guidance.

• High School Diploma or Equivalent AND Seven (7) Years of extensive experience in multi-specialty coding, E&M coding, procedural/surgical coding, as well as knowledge of governmental billing and coding regulations including the “Teaching Physician Guidelines”
• Associate’s Degree AND Five (5) years extensive experience in multi-specialty coding, E&M coding, procedural/surgical coding, as well as knowledge of governmental billing and coding regulations including the “Teaching Physician Guidelines”
• Certified Professional Coder (CPC), Registered Health Information Technician (RHIT), OR Certified Coding Specialist
  - Physician (CCS-P)

• Bachelor’s Degree

• Conducts compliance-related audits and reviews. Coordinates with departments to conduct compliance audits and reviews. Such reviews take into consideration the rules and regulations for CMS, multistate (WV, OH, PA, MD, etc.), and payor specific regulations for chart documentation, valid coding and billing, and medical necessity support to prevent fraud, waste, and abuse as mandated by OIG compliance program requirements. Coordinates with departments to conduct audits across WVUHS and all its affiliates.
• Coordinates with departments to conduct compliance audits. Evaluates the scope of the audit and develops/completes the required compilation of data analytical reports (independently of IT and/or Data Analytics) from the appropriate application or software in order to identify the audit universe and then select the appropriate sample based on the scope of the audit criteria.
• Formulates and defines, along with the Director of Provider Compliance and VP of Corporate Compliance, the scope and objectives of audit or review.
• Researches regulatory requirements that pertain to the audit or review.
• Reviews medical record, billing, or other relevant documentation.
• Develops and writes audit reports which outline audit findings, recommendations and corrective actions as needed.
• Leads and conducts meetings with respective departments or individuals to review audit reports and develop corrective action plans as necessary.
• Planning, developing and conducting presentations for internal and external departments.
• Coordinates educational activities with the Director of Provider Compliance and VP of Corporate compliance to ensure organizational compliance education needs are met.
• Conducts and/or facilitates audit training/education activities of the Compliance Department which may include individual or group training based on the results of internal audit reviews.
• Reviews clinical issues with physician to ensure appropriate physician documentation, coding, and reimbursement.
• Conducts and/or facilitates educational activities of the Compliance Department which may include individual, group, and/or online training development.
• Assists in planning of informational programs, education, and training sessions to educate staff, both departmentally and institution wide, of current and changing compliance and regulatory requirements.
• Develops and conducts ongoing compliance, documentation guidelines and billing education for new staff, including physicians, allied health and advanced practice professionals, and coding personnel. Additionally the auditor/educator assists with auditing and education, and acts a subject matter expert to the Enterprise Information Management team for both professional and hospital coding.
• Development of Policies/Procedures.
• Assists in review of new or revised regulations or…