COMPLIANCE AUDITOR- PATINT FINANCE SERVICES

COMPLIANCE AUDITOR- PATINT FINANCE SERVICES

About Us :

At Sinai Health System d / b / a Sinai Chicago, we take health care personally. Excellence in health care is about more than just medicine, technology, tests, and treatments, it is about really caring for people with dignity and respect. That is what we do. We are dedicated to providing the best care to meet the needs of people, for our community, for our patients and for you.

Position Purpose :

The Patient Financial Services Compliance Auditor role is responsible for ensuring that Hospital and Professional Billing and documentation maintains current compliance in accordance with CMS, OIG, state, payer and internal coding and billing guidelines under the direction of the Chief Revenue Officer. This individual is responsible for performing compliance audits on physician and hospital charts / accounts, provides an accounting of all audits, and assesses the controls in place to assure that audits are effective and root causes of inefficiencies are resolved daily. This role serves as the department liaison responsible for reacting and responding to all government inquiries, requests, and audits. This role also provides education to new providers and administers ongoing education to existing providers. This position works in partnership with all team members within Revenue Cycle Management and the department vendors to ensure system denial mitigation, billing accuracy and reimbursement collections daily.

Key Job Activities :

• Assists in ensuring compliance with CMS, OIG, and internal coding and billing compliance guidance as dictated by the SMG Coding and Billing Compliance Plan.
• Provides annual education and updates to all providers on newly emerging coding and documentation trends, changes to coding and documentation practices, and alerts all providers as necessary to the same.
• Assists in education with new providers that have been identified by the revenue cycle / coding team as not in compliance with the expected error rate threshold or as having other coding and documentation issue as a result of the new provider coding hold.
• Conducts a yearly 10-chart audit for all employed providers in compliance with the OIG guidance on this topic.
• Conducts additional reviews, audits, and / or education as necessary and as identified by the compliance and revenue cycle departments.
• Serves as a member of the All-Payer Response team and maintains the All-Payer Response Tool.
• Assists in the maintenance of the Sinai Business Integrity Program as needed by attending team meetings, representing the BI Office in meetings outside the office, attending trainings, and responding to reports of non-compliance.
• Performs other duties as assigned.

Education and Work Experience :

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