Job Description

Position Summary:

Minimizes risk to the organization by conducting Corporate Compliance audits, investigations and training throughout all affiliates. Guides system administration and RGHS management to ensure compliance with local, state and federal laws and regulations; in addition to contract obligations. Acts as subject matter expert for building and continually optimizing the system’s EMR. Work is often confidential and sensitive; therefore requires a high level of professionalism and strong communication skills. Requires a high degree of mental and visual acuity as attention to detail, critical thinking and decision making is required. Errors greatly impact the hospital’s compliance risk, including legal fines, loss of revenue and statistics. Strong analytical skills, project management experience, and training skills to guide Physicians, staff and system Management in interpretation of rules and regulations are essential.

Status: Full-Time

Department: Compliance

Location: Remote

Schedule: Monday-Friday, 8:00am - 4:30pm

Key Responsibilities:

• Abides by the standards of Ethical Coding as set forth by the American Health Information Management Association.
• Manages projects independently, prepares governmental disclosures and facilitates external audits by regulatory agencies while working with RGHS Administration and Management.
• Coordinates and conducts audits to assess compliance with payer regulations and contract obligations. Audits include, but not limited to revenue cycle (Clinical documentation, EMR work flows, registration, coding, charging, billing, payments and denials), financial statements, payments and attestations; grants, RGHS employees and contractors for governmental exclusions and payment agreements
• Interviews key staff with professionalism and respect in order to identify cause analysis of issues identified.
• Collaborates with health care professionals to discuss findings and offer advice and education as to how to improve compliance
• Develops reports reflecting audit results and reports findings to Compliance Director, RGHS Administration and management
• Develops corrective action plans with Management and assists with implementation when necessary.
• Performs follow up audits to ensure monitors are implemented and effective.
• Analyzes studies that have been prepared by government and professional associations to assess risk and opportunity for assigned departments
• Identifies compliance benchmarks for assigned areas and performs analysis for risk assessment
• Collaborates with System Directors and/or administration regularly to ensure awareness of any regulation changes impacting their departments
• Researches and assists Compliance Director, RGHS management and administration with approvals for new business growth for the system
• Approves and collaborates with system management and administration on margin improvement initiatives, often times assists or provides the training to staff involved in implementing, to ensure compliance
• Acts as Subject Matter Expert in the continued building and optimization of the systems EMR in areas of clinical documentation, work flows and impacts on the revenue cycle to ensure compliance. Performs presentations for clinicians on appropriate documentation in the EMR
• Designs and implements training to ensure compliance. Focuses include, but not limited to Fraud, Waste and Abuse, revenue cycle clinical documentation, coding, charging, billing and denial appeals for physicians, health care providers, HIM coders and other applicable RGHS employees
• Performs and manages internal investigations into reports of non compliance (fraud, waste and abuse) by RGHS employees or external sources as directed
• Interviews system management and staff with respect and professionalism
• Completes report and investigation in a timely manner
• Reports findings to Compliance Director and follows through as directed; including assisting HR with information and interviews to ensure appropriate discipline of employees
• Performs cause analysis of non compliance
• Facilitates corrective action and monitors in affected departments with management
• Performs follow up audits in timely manner to ensure compliance
• Facilitates and manages under the general direction of Compliance Director external investigations into the system by agencies such as OIG, DOJ, OMIG, FBI, Medicare and Third Party payer fraud units. Represents the system in a positive and professional manner when communicating with agencies.

Minimum Qualifications:

• AAS or BS in Health Information Management, Health Care Administration, Finance, or Accounting, and experience with healthcare compliance. A combination of healthcare work experience, credentials and/or education will be considered.
• Minimum five years of healthcare experience with CMS and local payers regulations.

Required Licensure/Certification Skills:

• RHIT, RHIA, CCS or CCS-P preferred.
• Relevant health care related certification or other experience may be considered in lieu of above certifications.
• Compliance Board Certification a plus

Rochester General Health System is an Equal Opportunity / Affirmative Action Employer. Minority/Female/Disability/Veteran

EDUCATION:

LICENSES / CERTIFICATIONS:

PHYSICAL REQUIREMENTS:

Sedentary - Sedentary roles are primarily office-based and require prolonged sitting (67–100% of the workday) with minimal physical effort and lifting limited to under 10 lbs. Fine motor skills are necessary for computer work, writing, and telephone use, supported by clear visual and auditory ability. Cognitive and emotional demands are high due to extended concentration, frequent interruptions, independent decision-making, and information processing. Although physical exposure is low, administrative areas within healthcare environments may occasionally involve contact with infectious agents. Some roles may require flexible hours, TB screening, or a valid driver’s license.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee’s physician or delegate will be considered for accommodations.

PAY RANGE:

$63,000.00 - $78,000.00

CITY:

Rochester

POSTAL CODE:

14617

The posted pay range is a good faith representation of potential base pay for this position. It may be modified in the future and eligible for additional pay components. Individual annual salaries/hourly rates could vary based on position details and FTE. Pay is determined by considering factors including, but not limited to, experience, relevant qualifications, specialty, internal equity, locations, and contracts.

Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.