Technical Compliance Auditor

It’s inspiring to work with a company where people truly BELIEVE in what they’re doing!

When you become part of the Chapters Health Team, you’ll realize it’s more than a job. It’s a mission. We’re committed to providing outstanding patient care and a high level of customer service in our communities every day. Our employees make all the difference in our success!

Role:
The Technical Compliance Auditor audits and reviews technical components of Conditions of Participation and Conditions of Payment, billing and other non-clinical items included in the annual Compliance Auditing and Monitoring Plan to ensure compliance with all regulatory guidelines and quality initiatives.

Qualifications:

• High School diploma or equivalent; Associate’s degree preferred
• Minimum of three (3) years’ applied billing experience; Hospice billing preferred
• Knowledge of Medicare, Medicaid and Private Insurance billing regulations
• Certified Professional Coder preferred
• Advanced computer knowledge; advanced level of skill in Excel, PowerPoint and Word
• Knowledge of a variety of billing issues
• Excellent communications skills (written and verbal) and interpersonal skills
• Ability to work with minimal supervision

Competencies:

• Satisfactorily complete competency requirements for this position.

Responsibilities of all employees:

• Represent the Company professionally at all times through care delivered and/or services provided to all clients.
• Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse.
• Comply with Company policies, procedures and standard practices.
• Observe the Company's health, safety and security practices.
• Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company.
• Use resources in a fiscally responsible manner.
• Promote the Company through participation in community and professional organizations.
• Participate proactively in improving performance at the organizational, departmental and individual levels.
• Improve own professional knowledge and skill level.
• Advance electronic media skills.
• Support Company research and educational activities.
• Share expertise with co-workers both formally and informally.
• Participate in Quality Assessment and Performance Improvement activities as appropriate for the position.

Job Responsibilities:

• Conducts prospective and retrospective documentation audits to confirm compliance with documentation and billing rules and regulations set forth by the Centers for Medicare and Medicaid Services (CMS), Medicare carrier and Fiscal Intermediary State regulations and internal policies. Presents findings as directed.
• Interacts with department leaders and/or their staff to discuss billing compliance issues and uses the information for recommending change of existing procedures or processes. Develops reports identifying positive and negative billing trends through audits and interaction with departments.
• Selects targeted accounts to review to enhance billing quality to ensure compliance with state and federal payer regulations.
• Utilizes Direct Data Entry (DDE) software to determine compliance with billing requirements and Hospice Conditions of Participation.
• Ensures effectuation of billing adjustments that are identified in compliance audits, e.g., related to late Face-to-Face Encounters that do not meet exceptional circumstances for patients newly admitted to their third or later benefit period; works with department leaders to ensure corrective actions are taken to mitigate or prevent such non-billable days/write-offs.
• Ensures the Hospice Item Set (HIS) Admission and Discharge record submissions/resubmissions to CMS are reported timely, completely, and accurately, in order to meet and exceed the annual 90% threshold metric.
• Maintains a thorough and up-to-date understanding of CPT, ICD-9-CM and ICD-10 and HCPCS coding principles, governmental regulations, and third-party guidelines regarding documentation and/or billing compliance.
• Participates in non-clinical audits as described in the annual Compliance Auditing and Monitoring Plan including, but not limited to, patient files, contractual payments, etc.
• Assists with efforts to prepare records for external agency reviews; includes auditing, copying, and summarizing findings.
• Performs other duties as assigned.

Compensation Pay Range:

$40,923.96 - $58,931.45

This position requires consent to drug and/or alcohol testing after a conditional offer of employment is made, as well as on-going compliance with the Drug-Free Workplace Policy.