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Compliance Auditor- The Compliance Auditor works directly with the Compliance Directors, Chief Compliance Officer and the rest of the Duke Health community in helping build, monitor and educate on compliance, billing and other regulatory practices. Provides education and guidance on documentation integrity and its importance in both the clinical care of patients and billing practices. Manages all compliance, documentation and billing activities for assigned department(s) across the Duke Health physician practices. Conducts non-routine investigations to ensure adherence with federal, state and other industry regulations.
The specific role will help support the multispecialty providers across Duke Health. Experience in managing compliance activities, providing education, medical auditing, and / clinical documentation enhancement is highly preferred, in addition to possessing leadership and highly developed communication skills, and project management and teamwork skills
Compliance/Integrity Program Management
- Provides oversight to the implementation and monitoring of the compliance program for assigned DH department(s) to include departmental, divisional and individual provider review and education.
- Scope of responsibility includes compliance issue management, corrective action planning including implementation of any necessary changes and monitoring adherence to these changes over time.
- Proactively identifies trends and needs of assigned clinics, and conducts regular meetings and training to include clinic leadership and staff.
- Provides formal written communication to leadership at the completion of reviews and risk assessments with pertinent findings and recommendations.
- Prepares products and services that add value and enhance education for providers and other identified staff.
- Communication, both written and verbal, is presented in a professional and courteous manner, is clear and concise, supported by regulatory, DH policy, or standard operating procedures/processes, and provided within requested or required timeframes.
- Adheres to HIPAA policies and is diligent in maintaining
- Fully promotes Duke Health Values and Behaviors of Excellence, Safety, Integrity, Diversity, and Teamwork.
- Fosters an atmosphere of collaboration both as Team Captain and Team Member, for assigned reviews, developing strong working relationships with internal and external partners.
- Develops positive relationships with SOM, DHTS, DUHS, PRMO and collaborative partners including Revenue Managers, Maestro Care Concierges, and Department/Division leadership.
- Recognizes importance of team cohesiveness and participates in team projects and activities with positive demeanor.
- Identifies opportunities to enhance work culture, providing assistance in arranging activities, and supporting participation.
- Performs reviews by regulatory guidelines and leadership instructions, including completion of reviews within targeted time frames, communication to providers of results, and scheduling education with identified providers within a timely manner.
- Provides education in accordance to DH Compliance policies and standards, including training for new providers, education focused on review opportunities, and group training of identified trends or other clinic needs.
- Provides support in an effectively and efficient manner in all work, including the review process, communication of results, both in formal reports and email communication, as well as in research of inquires relying on current, credible resources for providing official guidance on behalf of the DH Compliance department.
- Maintains appropriate and industry standard credentials through continuing education programs and is committed to personal and professional development utilizing available training resources.
- Prepares identified corrections or adjustments within the specified timeframe for compliant response to payer.
Work requires a general business background generally equivalent to a Bachelor's degree in business administration, accounting, management, healthcare administration, or other related degree.
- Four years of experience related to legal, and regulatory compliance, patient advocacy, supervisory role in patient financial services or HIM services, or other relevant experience.
- Compliance, Health System, or Revenue Cycle professional coding or billing experience utilizing an electronic health record, Epic platform preferred
- Experience with Risk Adjustment coding and documentation, and value-based care models
- Public speaking and presentation skills preferred
- Excel, Word, and PowerPoint skills
Knowledge, Skills and Abilities
- Ability to effectively communicate with all levels of department leadership and staff both in oral and written communication, including the interpretation of complex regulatory guidelines
- Possess critical thinking and problem solving skills, with a focus on accuracy and detail
- Demonstration of a high level of integrity and ethical standards
- Knowledge and experience in working with Professional Coding and Billing regulations, with both federal and commercial payers, including state regulatory requirements for providers
Degrees, Licensures, Certifications
- CPC, CCS or equivalent, required (within 1 year of hire) - for coding and billing oversight
- CRC or equivalent, required (within 1 year of hire) - for value-based care oversight
Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunities without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essentialjob functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.
Serving With Purpose
You’ve always been called to care – and we share your dedication to making a meaningful difference in the community. With the entire team united through this purpose, there are no limits to what we can achieve together. You’ll have all the resources you need here to leave a legacy of exceptional service because at Duke Health we support you in your calling to care.
Awards and Recognition
Duke Health is consistently recognized as a top employer for our dedication to the team members and the patients we serve.
On Forbes list of Best Large Employers, we are the #1 healthcare recipient in North Carolina for 2023.
Our hospitals are consistently recognized as LGBTQ Healthcare Equality Leaders by Healthcare Equality Index.
We are among about 9 percent of U.S. hospitals that hold the American Nurses Credentialing Center’s Magnet Recognition honor.
CHIME Digital Health Most Wired recipient since 2018, honoring our ability to elevate the health and care of communities around the world.
We are proud to be named as the #1 healthcare system in North Carolina on Fortune’s America’s Most Innovative Companies 2023 list.
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