Corporate Responsibility Auditor Senior

It's more than a career, it's a calling.

MO-REMOTE

Worker Type:

Regular

Job Highlights:

Exciting opportunity for an Corporate Responsibility Auditor Senior role SSM Health! Preferred data analytics background is a plus.

Job Summary:

Enhances overall financial performance by reviewing all assigned government audit denials and determining appropriate follow-up actions. Appeals denials which are found to be unsubstantiated through review of the medical record and/or billing information. Tracks assigned cases and enters data of audit related information into web-based audit tracking tool. Supports staff education, quality improvement, policy development, and overall improvement of financial performance. Supports and guides in the development and enhancement of an organized system to monitor, evaluate, and improve the quality and best practice methodology related to the corporate compliance program. Ensures that commitment to the compliance program is communicated and ensures the program’s effectiveness. Assists in meeting appropriate regulatory standards related to billing, reimbursement and third-party contractual arrangements. Ensures that employees (including physicians) comply with policies, third party requirements and federal regulations. Provides leadership in process improvement and collaborative strategies with others as well as creative approaches to complex situations.

Job Responsibilities and Requirements:

PRIMARY RESPONSIBILITIES

• Initiates development and maintenance of compliance program, including compliance awareness education, implementation and maintenance of compliance policies and procedures, and monitoring of policy adherence and enforcement.
• Identifies, researches, summarizes, presents, educates and implements traditional and non-traditional approaches to multi-faceted issues to provide best practice.
• Performs or conducts compliance investigations and presents recommendations to physicians and committees.
• Implements process improvements and supports system wide implementation of new initiatives.
• Provides leadership and facilitates change in application of solutions requiring organized processes and outcomes.
• Documents and discusses detected deficiencies in billing and reimbursement with personnel of departments and provides recommendations to prevent future deficiencies. Develops and maintains processes to monitor program effectiveness through audits, analysis of employee hot-line reports, post office box inquires and other feedback mechanisms.
• Remains current with government and third party billing regulations, government initiatives on fraud and abuse, and other related legislation.
• Researches and performs analysis of compliance work plan. Coordinates audits/record reviews and provides education to departments when necessary. Implements corrective actions in cooperation with both clinic and business office management.
• Serves as resource to all internal and external customers, answering questions, researching topics and providing information regarding coding, documentation and compliance issues.
• Partners with other individuals/departments to foster best practice methodology and compliance.
• Performs other duties as assigned.

EDUCATION

• Bachelor’s degree, or equivalent combination of experience and education

EXPERIENCE

• Three years' experience

PHYSICAL REQUIREMENTS

• Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
• Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
• Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
• Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
• Frequent keyboard use/data entry.
• Occasional bending, stooping, kneeling, squatting, twisting and gripping.
• Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
• Rare climbing.

REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS 

• None

Department:

8821000033 Corp Responsibility

Work Shift:

Day Shift (United States of America)

Scheduled Weekly Hours:

40

Benefits:

SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.

• Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE). 

• Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.

• Upfront Tuition Coverage: we provide upfront tuition coverage through FlexPath Funded for eligible team members. 

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SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity,pregnancy, veteran status, or any other characteristic protected by applicable law. Click here to learn more.