University of Michigan Health-Sparrow · 3 days ago
UMH Sparrow Health System -SENIOR COMPLIANCE AUDITOR
Lansing, MI
Full-time
Onsite
Senior Level
5+ years expUniversity of Michigan Health-Sparrow is seeking a Senior Compliance Auditor to ensure that Revenue Cycle Coding and Billing are compliant with State and Federal regulations. The role involves investigating compliance issues, leading audit activities, and collaborating with various health system units to ensure compliance with applicable laws and regulations.
Hospital & Health Care
Responsibilities
Ensures conformance with applicable laws, regulations and Medicare/Medicaid reimbursement rules to ensure UMHS is in compliance with federal, state and/or local regulations
Monitors, analyzes and reports on laws, regulations, audits and industry standards that impact the organization
Develops and maintains Professional and Hospital billing issues on the Revenue Cycle Compliance Work Plan
Reviews the OIG Work Plan, recent payer audits (including OIG Reports), industry communications and other resources to establish and prioritize
Recommends appropriate actions based on findings
Responsible for reviewing, writing and updating Revenue Cycle Billing policies and procedures to ensure that the Revenue Cycle operations are in compliance with all federal and state regulations, payer rules and other reimbursement requirements
Works with Revenue Cycle Management and other staff to investigate compliance issues
Participates, leads and collaborates with members of Revenue Cycle Billing Policy/Compliance work groups to address compliance and billing operations issues
Coordinates/collaborates on the response to OIG subpoena's or other government agency subpoenas
Collaborates with other health system units including but not limited to Health System Legal Office, UMHS Compliance Office and Office of Clinical Affairs to ensure appropriate communication on regulatory issues
Responds to inquiries from billing units and clinical departments regarding compliance issues
Investigates and issues reports on identified compliance issues
Provides staff support to Corporate Compliance Audit Committee (CCAC)
Monitors laws, regulations and standards that impact the organization
Provides education on applicable rules and regulations and to improve operational process
Provides clinical and operational expertise for the RCE team
Serves as a department expert on third-party payer issues, including working closely with the Revenue Cycle Third Party Payer staff to ensure compliance with rules, regulations and contractual obligations
Ensure the Revenue Cycle policies on internal and external websites are up to date
Serves as the lead for all Non-Physician Practitioners (NPP) billing and documentation issues and projects including reviewing changes to NPP requirements by payers
Works with the lead Physician Assistant, the Ambulatory Care lead for Nurse Practitioner issues and UMHS Nursing
Qualification
Required
Must have one of the following: Certified in Healthcare Compliance (CHC) by the Health Care Compliance Association (HCCA), Certified Professional Coder (CPC) by the American Association of Procedural Coders (AAPC), Certified Inpatient Coder (CIC) by the American Association of Procedural Coders (AAPC), Certified Coding Specialist (CCS) by the American Health Information Management Association (AHIMA), Registered Health Information Management Technician (RHIT) or Registered Health Information Administrator (RHIA) by the American Health Information Management Association (AHIMA)
Minimum 5 years of either coding experience for inpatient and outpatient records, or revenue cycle management or equivalent work experience
Bachelor's degree in Health Information Management, or other healthcare related field
Knowledge of ICD coding classification systems
Working knowledge of coding for third-party payers, including CMS guidelines and reimbursement compliance
Knowledge of health information systems and database technology
Able to communicate effectively with team members and management
Detail-oriented, good organizational skills, analytical, strong problem solving/investigative skills, and ability to be self-directed
Ability and willingness to exhibit behaviors consistent with standards of performance improvement and organizational values (e.g., efficiency & financial responsibility, safety, partnership & service, teamwork, compassion, integrity, and trust & respect)
Demonstrate personal integrity, enthusiasm and empathy to internal and external customers
Preferred
2-5 years of professional experience as a coding/HIM manager or documentation specialist in a hospital or health system or revenue cycle management
Master's degree
Formal course study in Human Anatomy and Physiology, ICD and CPT coding, and Medical Terminology
Knowledge of HIPAA and other compliance requirements
Knowledge of MiChart (Epic)
Knowledge of University policies and procedures
Company
University of Michigan Health-Sparrow
As Mid-Michigan’s premier healthcare organization and the region’s largest private employer, University of Michigan Health-Sparrow provides quality care to hundreds of thousands of people each year.
5001-10000 employees
Funding
Current Stage
Late StageCompany data provided by crunchbase