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Network Healthcare Compliance Auditor

Company: St. Lukes University Health Network
Location: Allentown
Posted on: December 4, 2019

Job Description:

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.The Network Healthcare Compliance Auditor works closely with the Manager, Network Compliance in the day to day activities to provide a comprehensive, effective and efficient compliance program for the St. Lukes University Health Network. DUTIES AND RESPONSIBILITIES: - Compliance Committee: Serves as a member of the compliance committee. The Compliance Committee meets regularly and has responsibility for and oversight of the reporting, monitoring, and tracking of all identified compliance issues and subsequent corrective action plans. - Policies and Procedures: Develops, initiates, maintains, and revises policies, procedures and practices for the general compliance and operations of SLUHN and its related activities to prevent illegal, unethical, or improper conduct. - Education and Training: a) Assists with developing and coordinating a multifaceted educational and training program that focuses on the elements of the Compliance Program including HIPAA and b) Assists with developing other educational programs as well as working to ensure that all appropriate business partners, employees and management are knowledgeable of and comply with, pertinent federal and state standards. - Reporting and Corrective Action Plan: Conducts investigation of alleged violations, as requested by the Manager, Network Compliance. Develops/implements corrective action plans for the resolution of problematic issues. - Auditing and Monitoring: Initiates and completes the investigation, auditing, review and analysis of general compliance, billing, HIPAA Privacy, and other matters to ensure compliance with governmental regulations and internal policies. Identifies areas for audit opportunities based on industry performance, regulatory focus areas and risk areas within the organization. Must demonstrate strong critical thinking and analytical skills when performing various audits. - Disciplinary Guidance: In coordination with the Manager, Network Compliance, works to enforce compliance standards through disciplinary processes and works to ensure that disciplinary actions for compliance matters are consistent across SLUHN. - Communication: Institutes and maintains an effective compliance communication program for the organization, including promoting (a) use of a compliance hotline, (b) heightened awareness of SLUHN Code of Conduct, and (c) understanding of new and existing compliance matters and related policies and procedures. - Skilled in conducting and analyzing complex data, evaluating information and drawing logical conclusions. - Demonstrates the ability to research complex, legal, regulatory, and contractual documents, for interpretive and analytical purposes, to ensure compliance with such areas identified by the Office of Inspector General, Medicare/Medicaid, and Stark and Anti-Kickback Laws. PHYSICAL AND SENSORY REQUIREMENTS: Must possess hearing, seeing, speaking and reasoning senses necessary to carry out job duties. Must be able to sit for long periods throughout the day, with intermittent periods of standing, walking, bending, twisting and reaching necessary to carry out duties of job. Sedentary work, with occasional lifting/carrying of objects such as office supplies, files, etc. with maximum weight of ten pounds. Must be able to pay close attention to details, concentrate on work and observe work of others. MINIMUM QUALIFICATIONS EDUCATION: Bachelors degree from an accredited college or university with a nursing, RHIA management major or equivalent education and/or experience is required. TRAINING AND EXPERIENCE: Three+ years experience in healthcare compliance. The following experience is highly desirable: Medical record audit experience in hospital technical and/or professional fee coding services; or Nursing experience in an acute care hospital, case management, utilization management, consulting, clinical auditor, or state health department focused on compliance related activities. Internal audit or accounting experience. Must possess knowledge of Corporate Compliance related laws and regulations imposed on health care systems by various payers and regulatory and government agencies. Certification in Healthcare Compliance (CHC), CPC, or CCS highly desired. Excellent computer skills (e.g. Internet, Microsoft Office, Epic). Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!! St. Luke's University Health Network is an Equal Opportunity Employer.

Keywords: St. Lukes University Health Network, Allentown , Network Healthcare Compliance Auditor, Accounting, Auditing , Allentown, Pennsylvania

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