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AUDITOR COMPLIANCE

Job ID
15480533
Category
Quality and Compliance
Department
Compliance
Location
Albuquerque, NM
Date posted
04/08/2021
Position Summary:Provide support for clinical compliance program. Assist in developing compliance audit plans, and monitor clinical component practices to ensure ongoing regulatory compliance. Assist with compliance training program. Ensures adherence to Hospital and Departmental Policies and Procedures. No patient care assignment.Accountability:
  • COMPLIANCE - Provide support for clinical compliance program

  • COMPLIANCE - Review for proper compliance with government regulations by conducting audits and/or assisting outside auditors. Research audit issues, develop audit scope, conduct audits, make recommendations, and prepare audit reports

  • COMPLIANCE - Investigate possible compliance issues and/or practices, and help develop corrective action plans as necessary to achieve and maintain compliance

  • COMPLIANCE - Respond to internal questions regarding compliance issues

  • INQUIRIES - Log all compliance-related inquiries and responses; maintain the Compliance Department’s logging/recording database

  • COMMITTEES AND MEETINGS - Participate in hospital/medical staff meetings and committees as required

  • COMMUNICATION – Perform compliance-related audits and present audit findings to key stakeholders in affected units or departments; document Corrective Action Plan and conduct follow-up monitoring and auditing to ensure corrective action items are initiated and completed

  • ISSUE RESOLUTION - Monitor, evaluate and resolve concerns or problems identified by external (e.g., patients, visitors, vendors, payers) and internal customers (e.g., employees, volunteers) forward to appropriate departments or units for further evaluation or action

  • Education Requirements:
  • Bachelor's Degree in related discipline

  • Experience Requirements:
  • Medical anatomy, terminology, ICD 9 & ICD 10 and CPT/HCPCS medical coding, comprehensive knowledge of current and developing issues and trends in compliance, medical coding and auditing procedures

  • 2 years directly related experience

  • Physical Demands Requirements:
  • Sedentary Work: Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

  • Licensure/Certification Requirements - Preferred:
  • Certified Professional Medical Auditor Certification or certificate eligible

  • Certified Professional Coder (CPC)

  • Licensed Registered Nurse (RN) in State of New Mexico or as allowed by reciprocal agreement by State of New Mexico

  • Professional licensure as appropriate to the clinical objectives of the unit:
  • Certified Professional Medical Auditor Certification or certificate eligible

  • Certified Professional Coder (CPC)

  • Licensed Registered Nurse (RN) in State of New Mexico or as allowed by reciprocal agreement by State of New Mexico

  • Working Conditions Requirements:
  • No or min hazard, physical risk, office environment

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    • Quality and Compliance, Albuquerque, New Mexico, United StatesRemove