Compliance Audit Nurse

SUMMARY : Establishes appropriate internal controls related to asset protection and insures throughout the organization : adherence to compliance plans; Medicare regulation; medical record audits; HIPAA privacy compliancePrimary Responsibilities

• Conducts compliance audits including, but not limited to, random chart audits, in accordance with established criteria; ensures proper controls are in place and effective
• Develops and ensures annual compliance training is conducted for physicians and staff
• Responds appropriately to violations of Compliance Plan and brings compliance issues to attention of Executive Administrator, Managing Partner, or outside consultant as necessary
• Works with Compliance Committee to identify organization's compliance risks, develops compliance assessment plan at least annually, ensures compliance assessment plan is followed and that corrective action is taken when indicated
• Reports quarterly to the Compliance Committee and Executive Committee on the operation and effectiveness of the Compliance Plan
• Manages and oversees compliance with HIPAA regulations including the oversight of Business Associate Agreements; acts as a resource for Medicare and HIPAA regulations, and consequences of non-compliance to both
• Develops, implements, maintains, and monitors the Compliance Program policies, the Code of Conduct, the Notice of Privacy Practices, and HIPAA Privacy and Security policies
• Oversees and manages pay-for-performance such as MIPS
• Establishes appropriate internal controls
• Adheres to and supports the Compliance Plan policies, procedures, goals, and intent.
• Provides Committee support as needed.
• Reports incidents in a timely manner and within 24 hours.
• Participates in various personnel actions including but not limited compliance training for professional staff development.
• Updates and adheres to the Clinic's Policy and Procedures and the Code of Conduct.
• Maintains a flexible work schedule to accommodate any urgent compliance violation and / or complaint
• Assists with the management of daily operations with respect to participation in Value-Based Care Programs including but not limited to providing training and resources as necessary to physicians and staff.
• Performs other related duties assigned and incidental to the work described herein.Specific Areas of ResponsibilitiesIntradepartmental
• Participates in Clinic committees, provides input and ideas to improve Clinic services and operations
• Develops a working relationship with all Physicians, Clinic personnel, and Managers to ensure overall Clinic standards are met. Education, Experience, and Knowledge
• BSN Graduate of an approved school of Registered Professional Nursing (Master's degree preferred)
• Unrestricted license / compact license to practice in the State of Texas
• Experience with medical coding guidelines such as CPT, ICD-10-CM, and HCC coding for clinic physicians
• Coding Certification preferred

Minimum of five (5) years of experience in healthcare compliance and / or risk management.

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