Compliance & Audit Partner

Compliance & Audit Partner

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Description

Overview:

• Emory Healthcare, Office of Compliance & Privacy (OCP) seeks a Compliance & Audit Partner to support systemwide compliance and education initiatives, reporting, trends analysis, as well as policy and procedure management.
• This individual would be responsible for ensuring that a healthcare organization adheres to relevant laws, regulations, and industry standards, focusing on compliance risk areas and billing practices, while also providing ongoing educational support, and fostering a culture of compliance within the provider network.

Key Responsibilities:

1. Management & Communication:

• Support the OCP by addressing all relevant laws, regulations, and industry standards.
• This includes staying informed about changes in healthcare regulations and industry standards and update training accordingly.
• Formulate, review, and revise compliance policies and SOPs, as directed. Participate in enterprise compliance risk assessment.
• Investigate compliance matters reported via the Emory Trust Line and the EHC Compliance office.
• Work to ensure timely resolution of Compliance issues and facilitates communication of compliance related matters.
• Development governance-level reporting and metrics for the EHC Compliance Office, including but not limited to dashboards, board reporting, weekly, monthly, and annual compliance & ethics reporting.
• Work with Senior Compliance and Privacy Office leadership as well as other key clinical and operational leaders on compliance matters.
• Ensure that policies and procedures are effectively communicated and enforced throughout the organization.

2. Education & Training Program:

• Develop and delivery of compliance training programs for providers and other stakeholders to ensure accurate and compliant coding, with an emphasis on Evaluation and Management (E/M) services, procedural coding, and clinical documentation improvement.
• Participate in provider orientation to ensure coding and documentation expectations are clearly communicated.
• Collaborates with compliance auditors and revenue cycle teams to identify trends, address deficiencies to ensure compliance within the organization.
• Monitor regulatory changes from CMS, AMA, and other authorities; update educational materials accordingly.
• Track and report on education effectiveness and compliance risks.

3. Auditing & Reporting:

• Participate in specialty and high-risk internal audits and reviews to assess compliance with policies and procedures.
• Participate in compliance risk assessments, monitoring, tracking and trending.
• Investigate potential compliance violations and report findings to appropriate authorities.
• Collaborate with other departments and stakeholders to promote compliance throughout the organization.
• Serve as an additional point of contact for compliance-related questions and concerns.
• Ensure that policies and procedures are effectively communicated and enforced throughout the organization.

Minimum Qualifications:

• Bachelor's degree required. Masters (MA or MS) or Juris Doctorate (JD) degree preferred.
• Minimum of five years of experience in a healthcare organization. Healthcare compliance role is preferred.
• A minimum of five years of experience working as a medical coder, coding, auditor, and/or coding educator.
• Certified in Healthcare Compliance (CHC or CPCO) preferred. If no certification, must obtain one within 12 months of hire. - AHIMA or AAPC certification required (e.g., CPC, CCS-P, CCS, CPMA, COC)
• Strong knowledge of teaching physician rules, E/M leveling, and/or split/shared services.
• Experience working in multispecialty practices, hospital-based clinics, or academic medical centers preferred.
• Strong knowledge of HIPAA, Stark-Law, and other healthcare privacy regulations.

Knowledge, Skills, and Abilities Requirements:

• Ability to work on a team and work independently, when needed.
• Ability to adjust to changing work demands and multi-task.
• Thorough attention to detail and strong, problem-solving skills.
• Strong understanding of healthcare regulations, laws, and industry standards.
• Strong understanding of CMS and correct coding and billing requirements
• Excellent communication, interpersonal, and problem-solving skills.

Work Environment: Hybrid: 2-3 days/week onsite - Some local travel may be required for audits, training, or regulatory meetings.

Additional Details

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.

Accommodations: EHC will provide reasonable accommodation to qualified individuals with disabilities upon request. To request this document in an alternate format or to request a reasonable accommodation, please contact the Office of Leave and Accommodations.

Physical Requirements: (Medium-Heavy) 36-75 lbs., 0-33% of the work day (occasionally); 20-35 lbs., 34-66% of the workday; (frequently); 10-20 lbs., 67-100% of the workday (constantly); Lifting 75 lbs. max; Carrying of objects up to 35 lbs.; Occasional to frequent standing & walking; Occasional sitting; Close eye work (computers, typing, reading, writing); Physical demands may vary depending on assigned work area and work tasks.

Environmental Factors: Factors affecting environmental conditions may vary depending on the assigned work area and tasks. Environmental exposures include, but are not limited to: Blood-borne pathogen exposure; Bio-hazardous waste Chemicals/gases/fumes/vapors; Communicable diseases; Electrical shock; Floor Surfaces; Hot/Cold Temperatures; Indoor/Outdoor conditions; Latex; Lighting; Patient care/handling injuries; Radiation; Shift work; Travel may be required; Use of personal protective equipment, including respirators; environmental conditions may vary depending on assigned work area and work tasks.