Job Description

Overview

The Director of Finance and Reimbursement Compliance functions as a subject matter expert and the lead financial auditor for the Compliance Department. The Director of Finance and Reimbursement Compliance provides leadership and guidance, makes work plan recommendations, assists in the identification of compliance risk areas, the development of policies and departmental standard operating procedures, and provides collaboration in the development of corrective action plans for facilities. The Director of Finance and Reimbursement Compliance will assist with the development of system-wide compliance and internal audit functions for ARH hospitals, physicians and non-physician providers, ambulatory services, home services and other entities to ensure overall compliance. The Director is responsible for designing, planning, and executing coding and billing compliance audits following regulatory requirements and industry-accepted standards. The successful candidate will be expected to work in a collaborative manner across multiple ARH departments, including the Organization’s Finance and Legal Departments.

Special Instructions

Hybrid (Remote/On-Site). Must reside in Kentucky or West Virginia. Occasional travel (up to 20%) may be required for this role.

Responsibilities

• Responsible for the development of comprehensive financial audit plans in consultation with other Compliance Department members.• Executes financial audits and requested investigations independently.• Generates reports and analyzes data from numerous databases and software systems across ARH.• Performs/documents audit follow-up activities to ensure ongoing monitoring and that any requested corrective action plans are successfully implemented.• Prepares clear and concise reports that include sufficient detail and documentation to support procedures completed, related findings, and conclusions.• Maintains awareness of changes in auditing principles and practices and related areas in order to maintain professional competence.• Applies Internal Audit Standards established by the Institute of Internal Auditors. • Able to clearly and articulately discuss audit results with all levels of management and assist with education as needed and appropriate.• Maintains awareness of changes in statutes and regulations as well as compliance principles and practices in order to maintain professional competence.• Reviews all relevant programs and activities affected by industry regulations and recommends changes to address company procedures and practices that are non- compliant.• Reviews the Office of Inspector General’s work plan, creates education therefrom, and assists in the creation of compliance audits that address areas of concentration.• Research and respond to compliance inquiries.• Coordinate with the Chief Compliance & Privacy Officer in the development of the Compliance Department’s annual workplan.• Perform complex regulatory, audit, billing, coding documentation, medical necessity and other general compliance process and analyses that ensure the hospital receives appropriate reimbursements and adheres to applicable laws, rules, guidelines and regulations.• Participates in annual risk assessment and makes practical recommendations for process and/or policy improvements.• Provides education on reimbursement updates as appropriate. • Maintains professional certification. • Perform other duties as assigned.

Qualifications

Education

• Bachelor’s degree in Accounting or a related field (Finance, Business, etc.)

Minimum Work Experience

• Five (5) years of experience in a healthcare setting with specific experience in reimbursement or financial auditing

Licenses & Certifications

• Must currently hold, or obtain within 12 months of hire, one or more of the following:
• Certified Internal Auditor (CIA)
• Certified in Healthcare Internal Audit (CHIAP)
• Certified Fraud Examiner (CFE)
• Related certification

Required Skills, Knowledge, and Abilities

• Strong understanding of internal auditing and reimbursement laws
• Ability to research and interpret complex compliance requirements, including state and federal laws and regulations
• Strong analytical skills with the ability to assess billing, compliance, and related issues and provide recommendations
• Ability to translate compliance regulations into practical audit tools and audit scope documents
• Excellent communication and collaboration skills
• Demonstrated leadership abilities
• Proficiency in data analysis and reporting tools
• Ability to maintain confidentiality and handle sensitive information professionally
• Ability to manage multiple projects and deadlines simultaneously