Hospital Compliance Auditor

Join the transformative team at City of Hope, where we're changing lives and making a real difference in the fight against cancer, diabetes, and other life-threatening illnesses. City of Hope's growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, andtreatment facilitiesin Atlanta, Chicago, and Phoenix. our dedicated and compassionate employees are driven by a common mission: To deliver the cures of tomorrow to the people who need them today.

The Hospital Compliance Auditor conducts audits systemwide to determine organizational integrity within the Hospital Compliance Program and reviews hospital and provider-based site practices and procedures to ensure they adhere to all relevant healthcare regulations and laws. Audits to evaluate systems, charge capture, and hospital billing including detection and correction of documentation, coding, and billing errors and/or medical necessity of services billed.

The Hospital Compliance Auditor evaluates the adequacy and effectiveness of controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and federal and state regulations and guidelines, CMS and other third-party payor billing rules, and OIG compliance standards.

The Hospital Compliance Auditor serves as an institutional subject matter expert and authoritative resource on auditing and monitoring practices and interpretation and application of documentation and coding rules and regulations, and medical necessity of services delivered.

This position sits within the Healthcare Regulatory and Reimbursement Compliance vertical of the Ethics & Compliance program, is a member of the Hospital Compliance team, and reports to the System Manager, Hospital Compliance.

As a successful candidate, you will:

• Implements and manages a comprehensive systemwide proactive annual audit plan for the Hospital Compliance Program with focus on high-risk areas.
• Plans and performs hospital compliance related systems, revenue cycle, charge capture and claims audits, including accuracy and adequacy of documentation and coding related to hospital billing and/or medical necessity reviews.
• Initiates and manages auditing and monitoring as needed in conjunction with investigations and inquiries and assists with corrective action plans.
• Conducts analysis to identify inappropriate hospital billing and coding practices, identify and report compliance issues and concerns in addition to the claims and financial impact. Makes recommendations for corrective action.
• Distills and summarizes complex audit findings into digestible education and action items for stakeholders. Prepares written reports of audit findings and recommendations and presents to appropriate stakeholders; evaluates the adequacy of management corrective action to improve deficiencies; maintains audit records.
• Assists in validating accuracy of external audits, utilization management reporting, and other inquiries.
• Assists departmental management with the development of tools, templates, and process improvement recommendations.
• Assists in documentation and internal evaluation of Ethics & Compliance Program effectiveness consistent with professional standards.
• Understands where regulatory guidance and hospital policies and procedures might intersect in terms of compliant billing and coding, provide customer feedback to guide their decision making.
• In conjunction with department manager, provides education and feedback to stakeholders when audit deficiencies are identified.
• Stays current with Medicare, Medicaid and other third party rules and regulations, CPT, ICD10 coding updates and enhances professional growth and development by participating in educational programs relating to such topics. Serves as a system resource to answer billing appropriateness questions and those arising from audits, including government audits.
• Maintains knowledge of City of Hope Provider billing and collection systems, including knowledge of report writing capability, and works with Information Systems personnel to identify and request data needed for audits.

Your qualifications should include:

• Bachelor's degree; 3 additional years of experience plus the minimum experience requirement may substitute for minimum education.
• Seven (7) years auditing and coding experience.

City of Hope employees pay is based on the following criteria: work experience, qualifications, and work location.

City of Hope is an equal opportunity employer.

To learn more about our Comprehensive Benefits, please CLICK HERE.