Compliance Auditor II

POSITION SUMMARY: The Compliance Auditor II works under the direction of the Vice President of Compliance and performs audits primarily of financial matters relative to billing and coding accuracy. The Compliance Auditor II assess the accuracy of the company’s claims records and that controls in place are sufficient to to protect against fraud, abuse, and excessive waste of resources. Additionally, the Compliance Auditor II completes other non-billing audit protocols as assigned to assess the compliance of other identified compliance risk areas. The Compliance Auditor II is responsible for maintaining a working knowledge of all applicable rules and regulations and to stay abreast of any changes over time.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

The following is a summary of the major essential functions of this position. The position may require other duties, both major and minor, that are not mentioned below, and specific functions may change from time to time.

• Compiles, analyzes, and verifies medical records, and other pertinent data sources to conduct comprehensive audits of client’s medical records in an assigned facility per audit policies and procedures to determine standards of care compliance and medical necessity.
• Verifies the accuracy of the facility's records to safeguard against mismanagement, fraud, and abuse.
• Observes the delivery of clinical services, either in person or remotely, to assess how well the facility’s operations comply with the ARC policies and procedures, laws, government regulations and appropriate accreditation standards.
• Prepares and communicates audit results, conclusions and recommendations to the VP of Compliance, administration, managers, and facility staff as directed in a timely fashion.
• Assists in the development and implementation of audit recommendations and any additional follow-up actions, including adjustments and rebilling of accounts.
• Conducts chart audits and follows up on departmental action plans as a result of chart audit errors to ensure appropriate action has been taken and issues resolved.
• Audits patient accounts for accuracy of information, patient demographics, insurance information, etc., and for completeness.
• Assures accurate ICD-9/ICD-10 and CPT coding on patient accounts.
• Identifies and reports discrepancies in a timely manner.
• Submits conclusions and recommendations to appropriate level of management as directed by the VP of Compliance.
• Maintains working knowledge of current Medicaid requirements and stays abreast of regulatory guidance issued by the Centers for Medicare and Medicaid Services (CMS).
• Knowledgeable of the facility's EMR and billing systems.
• Assesses the degree in which documented notes comply with current standards and policies.
• Performs follow-up audits to ascertain that appropriate corrective actions were implemented.
• Maintains a collaborative working relationship within the department and with other departments.
• Demonstrates the ability to be flexible, organized and function under stressful conditions.
• Follows policies and procedures, performance improvement objectives, quality assurance initiatives, and safety and environmental standards.
• Keeps current in field through continuing education, professional publications, and journals.
• Communicates the mission, ethical business practices, and goals of the facility, as well as the focus of the Compliance department.
• Attends trainings, conferences, and seminars and stays abreast of all applicable compliance topics and regulatory issues applicable to the company’s activities.
• Maintains patient confidentiality at all times.
• Supports and maintains a culture of safety and quality.
• Performs additional duties as assigned.

MINIMUM QUALIFICATIONS

• Auditing and/or coding experience required.
• Experience in healthcare and/or behavioral health setting required.
• Excellent communication skills, both verbal and written, and the ability to share complex concepts with a mixed audience in a productive manner.

EDUCATION/EXPERIENCE/CERTIFICATION:

• Post-secondary degree with proven work experience in his/her field
• Experience in a behavioral health inpatient/outpatient environment preferred
• Ongoing education in behavioral health preferred
• Proficient in information technology and
• Working knowledge of HIPAA compliance

KNOWLEDGE/SKILLS/ABILITIES:

• General knowledge of clerical accounting practices, i.e., processing forms, reconciling accounts, billing preferred.
• Practical knowledge of computers and applicable software.
• Knowledgeable of office equipment.
• Able to communicate effectively in English, both verbally and in writing.
• Knowledge and understanding of recovery principles and recovery driven service system
• Knowledge of community health resources that support life improvement in physical, emotional, mental and spiritual health, economic security, employment, positive social and family interdependence and positive cultural identity
• Knowledge of the physical, emotional, intellectual, and spiritual impact of alcohol and other drugs on the individual and family
• Ability to maintain confidentiality and handle stressful situations in a calm and supportive manner
• Ability to exhibit professional and courteous behavior, consistent with the ARC mission statement, when interacting with persons of varying backgrounds and education levels to create a safe and healthy relationship with clients served

WORKPLACE ENVIRONMENT AND ESSENTIAL PHYSICAL REQUIREMENTS

• Ability to sit and/or stand for long periods of time
• Ability to read detailed health records
• Ability to lift and carry up to 10 lbs.
• Ability to operate computer and other equipment in the office
• Must have sufficient mobility to move around the office and the community

Addiction Recovery Care, LLCoffers a competitivebenefits package, including:

• Health,Dental and Vision Insurance
• Optional company-sponsored retirement plan (401k)
• Short-Term/Long-TermDisability Insurance
• Other ancillary insurance products i.e.,Critical Illness, Accident policies, etc.
• Paid Holidays and Vacation

Addiction Recovery Care, LLC is an equal-opportunity employer.