Clinical Compliance Auditor

The Clinical Compliance Auditor will report to the Clinical Compliance Supervisor and will assist with compliance auditing and monitoring activities within the homecare, hospice, personal care, outpatient therapy , NP services and LTAC agencies at LHC Group, Inc. (LHC) to ensure business areas have processes or policies in place to comply with applicable State and Federal laws and regulations related to Medicare and Medicaid rules and regulations, as described by the annual compliance work plan developed by the Chief Compliance Officer (CCO). The clinical and business areas will include, but are not limited to: eligibility, billing, coding, and clinical documentation. Independent monitoring includes performing audits (including detailed audits of patient medical records), creating reports, educating and following up with agencies to ensure processes exist that demonstrate compliance with applicable State and Federal laws, regulations, policies and procedures. The Clinical Compliance Auditor will coordinate internal audits, analyses, reviews and investigations of home health, hospice, personal care, outpatient therapy , NP services and LTAC locations within LHC as assigned by the CCO or the Clinical Compliance Supervisor and provide recommendations to improve compliance and internal controls with applicable State and Federal laws and regulations related to Medicare and Medicaid.

• Performs detailed patient medical record audits for home health, hospice, personal care, outpatient therapy, NP services and/or LTAC locations as assigned by the Senior Director of Clinical Compliance.
• Performs preaudit preparation including, but not limited to, sample selection/ stratification and agency notification of audit. Communicates with and educates the leaders of the appropriate agency/facility on the audit findings and through the creation of action plans based on audit results of the location audited, ensures recommendations are implemented by working cooperatively with the appropriate personnel.
• Performs due diligence billing audits and participates in discussions related to risk analysis identified from the clinical billing compliance audits upon request.
• Conducts Corporate Compliance Program education and training related to policies and procedures, regulations, or legislation that affects operations, as needed or assigned.
• Coordinates follow-up and resolution to investigations and audit findings as needed.
• Orients new Clinical Compliance Auditors as directed by the Senior Director of Clinical Compliance or the Clinical Compliance Supervisor.
• Provides on-going advice and resources to management in the area of process improvement to support Corporate Compliance Program effectiveness across the service lines.
• Maintains a working knowledge of Federal and State laws, regulations and policies applicable to LHC.
• Actively participates in conference calls, Teams meetings, and on-site meetings/training as assigned or requested to enhance the efficacy of the clinical compliance auditing program and to promote the overall culture of compliance throughout LHC.
• Conducts compliance-related investigations and follows up with Clinical Compliance Supervisor/Senior Director of Clinical Compliance or CCO for resolutions.
• Assists the CCO/Senior Director of Clinical Compliance or the Clinical Compliance Supervisor with any other tasks as assigned.

• Desired Experience: 5 years of post-acute care knowledge. (Home Health, Hospice, LTAC, OP therapy)
• HCBS Experience Preferred
• Registered/Licensed Practical Nurse degree/Physical, Occupational or Speech Therapist
• Significant exposure to Medicare/Medicaid reimbursement and regulations, internal auditing, healthcare, operations, patient care plans and medical records, Stark law, anti-kickback laws and fraud and abuse laws.
• Significant medical record audit experience
• Certified OASIS Specialist (COS-C)/HCS-O for RN ONLY
• Certified Coder (HCS-D) For RN only
• Proficiency in Excel functions and basic computer skills.