The Manager of Compliance Auditing and Monitoring will oversee the regional compliance audits performed for CHRISTUS Health to ensure consistent and accurate results. This position provides leadership and direction to the regional compliance auditors. Assists the system office with the development of the annual work plan. Conducts audit activities and prepares reports summarizing results of the audits. Works in conjunction with Regional Director of Compliance and Privacy and the system office on compliance work plans, staff education, internal and external audits and reviews, and provides assurance that the organization is operating in an efficient and effective manner.
A. Assist system office with developing the annual work plan and work plan calendar.
Analyze the work plan topics for each month and determine the scope of work for each activity. Review and understand any associated LCD's and CMS regulations to include in the scope of work.
Develop templates for each work plan activity to be utilized by the regional auditors.
Conduct monthly work plan meetings with the CHRISTUS compliance team to review the scope and templates for the scheduled work plan activities.
Serve as a resource for compliance auditor questions.
Prepare compliance auditing orientation materials and provide orientation to new auditors.
Monitor work plans completed by auditors including Corrective Action Plans (CAP's) to ensure CAP's are implemented and auditors have performed follow up.
Coordinate medical record and claim reviews with the CHRISTUS clinical and revenue cycle departments.
Perform monthly audits according to the established work plan calendar and prepares work plan summary slides.
Modify work plan calendar through the year to include additional audits based on audit results, risks, and corrective action plans.
Serve as a member of the regional compliance committee and presents summary of audit activities to the committee.
Provide subject matter expertise to the facility staff as directed by the Regional Director Compliance and Privacy.
Exercise due diligence in collaboration with Regional Director Compliance and Privacy to prevent and detect misconduct and wrongdoing. Undertake all reasonable steps to respond appropriately when an offense is detected and prevent future similar offenses. Ensure the enforcement of compliance program standards.
Provide results of audits and education to HIM, Revenue Cycle Departments, physicians, hospital and clinic operations regarding charging, documentation, and billing requirements.
Assist departments with development of corrective action plans (CAP's), as needed, and ensure CAP's are implemented and successful by performing follow up audits.
Communicate effectively with the compliance team, system office, and hospital departments following the CHRISTUS Core Values.
Assist Regional Director of Compliance and Privacy on OIG and other government audits/reviews and other compliance-related work, as assigned.
Maintain confidentiality and discretion regarding all work matters. Perform all duties in a manner that protects the confidentiality of patients and does not solicit or disclose any confidential information unless it is necessary in the performance of assigned job duties.
Ensure compliance with all policies, procedures, and standards as promulgated by state and federal agencies, the hospital, and other regulatory entities.
Perform other duties as assigned.
Bachelor's degree is required. Experience in healthcare compliance, auditing, or operations will be strongly considered.
Strong skills with Microsoft products (Excel, Word, and Power Point)
The Manager must have the ability to plan, develop, and present educational or program materials.
Five (5) years experience or more in healthcare revenue cycle or compliance.
Knowledge of healthcare compliance and integrity policies.
Strong knowledge of DRG, CPT, CDM and billing operations required.
Overall knowledge of hospital department operations.
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.