Moffitt Cancer Center
SPVR COMPLIANCE PROFESSIONAL AUDIT
Title:
Compliance Professional Audit Supervisor
Location:
Hybrid | Tampa, FL
Position Highlights
Supervises the Compliance Professional Auditors and manages professional services audits.
Oversees the Compliance Professional Auditors in evaluating the adequacy and effectiveness of controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements related to professional fee documentation, coding and billing.
Maintains and coordinates the Documentation and Coding Review Program; communicates and oversees the delivery of the Compliance Professional Auditor's audit results to the physicians, physician leadership, senior management, and staff.
Provides physician and coder education, assesses Compliance professional audits for quality assurance and makes recommendations for corrective action to leadership, faculty, coders, billers and other appropriate staff.
Acts as liaison with assigned faculty members, developing relationships and functioning as a resource to all providers and their staffs.
Serves as an institutional subject matter expert and authoritative resource on interpretation and application of documentation and coding rules and regulations, medical necessity of services delivered, and conducts enterprise risk assessments of potential and detected compliance deficiencies.
Ideal Candidate
Strong attention to detail and analytical skills, and the ability to interpret new laws and regulations, and communicate effectively both verbally and in writing.
Understands institutional risks and appropriate judgment to use a risk-based approach in planning and executing duties.
Works in both independent contributor and team roles (both as a team leader and team member).
Excellent interpersonal and presentation skills.
Ability to effectively prioritize and execute tasks in a fast-paced, dynamic environment.
Works proactively and collaboratively to fulfill the objectives of the Compliance Program and address matters with credibility, objectivity and confidentiality in accordance with professional auditing and investigative standards.
Abides by the highest ethical standards and exhibits these standards and the Cancer Center's mission, vision, and values in the performance of position duties.
Responsibilities
Supervises the Compliance Professional Auditors.
Evaluates the appropriateness of services and procedures billed based on supporting documentation.
Prepares written reports of audit findings and recommendations and presents to appropriate stakeholders.
Conducts risk assessments to define audit priorities by evaluating previous audit findings, management priorities, coding utilization patterns, national normative data, CMS and CCI initiatives, OIG work plans and advisories and healthcare industry best practices.
Develops compliance training content and provides one-on-one and group training to faculty physicians, advanced practitioners, billing and coding staff and others to ensure compliance with federal and state regulations and laws, CMS and other third‑party payer billing rules and internal documentation, coding, and billing policies and procedures.
Researches, abstracts and communicates federal, state and payer documentation, billing and coding rules and regulations; stays current with Medicare, Medicaid and other third‑party rules and regulations, CPT and ICD coding updates; serves as institutional subject matter expert and authoritative resource in these areas.
Qualifications
Bachelor's degree in Health Information Management, Business, or other relevant field; in lieu of a Bachelor's Degree, a High School Diploma/GED and 4 additional years directly related work experience for a total of 9 years directly related work may be considered.
CPC or CCS‑P, or other applicable AAPC or AHIMA credential.
Five (5) years' experience in Evaluation and Management coding and auditing or related work.
Knowledge of Medicare and Medicaid documentation and coding rules and guidelines; ICD/CPT/HCPCH/DRG/APC documentation coding rules; teaching physician guidelines; charge capture and reimbursement methodologies; E/M rules; medical terminology; healthcare compliance audit methodology, principles and techniques; CMS manuals; professional services reimbursement and repayment; confidentiality standards.
Ability to interpret and apply documentation and coding rules and regulations and to interpret medical records progress notes, handwritten and electronic chart entries, provider orders and other related documentation.
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Compliance Professional Audit Supervisor
Location:
Hybrid | Tampa, FL
Position Highlights
Supervises the Compliance Professional Auditors and manages professional services audits.
Oversees the Compliance Professional Auditors in evaluating the adequacy and effectiveness of controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements related to professional fee documentation, coding and billing.
Maintains and coordinates the Documentation and Coding Review Program; communicates and oversees the delivery of the Compliance Professional Auditor's audit results to the physicians, physician leadership, senior management, and staff.
Provides physician and coder education, assesses Compliance professional audits for quality assurance and makes recommendations for corrective action to leadership, faculty, coders, billers and other appropriate staff.
Acts as liaison with assigned faculty members, developing relationships and functioning as a resource to all providers and their staffs.
Serves as an institutional subject matter expert and authoritative resource on interpretation and application of documentation and coding rules and regulations, medical necessity of services delivered, and conducts enterprise risk assessments of potential and detected compliance deficiencies.
Ideal Candidate
Strong attention to detail and analytical skills, and the ability to interpret new laws and regulations, and communicate effectively both verbally and in writing.
Understands institutional risks and appropriate judgment to use a risk-based approach in planning and executing duties.
Works in both independent contributor and team roles (both as a team leader and team member).
Excellent interpersonal and presentation skills.
Ability to effectively prioritize and execute tasks in a fast-paced, dynamic environment.
Works proactively and collaboratively to fulfill the objectives of the Compliance Program and address matters with credibility, objectivity and confidentiality in accordance with professional auditing and investigative standards.
Abides by the highest ethical standards and exhibits these standards and the Cancer Center's mission, vision, and values in the performance of position duties.
Responsibilities
Supervises the Compliance Professional Auditors.
Evaluates the appropriateness of services and procedures billed based on supporting documentation.
Prepares written reports of audit findings and recommendations and presents to appropriate stakeholders.
Conducts risk assessments to define audit priorities by evaluating previous audit findings, management priorities, coding utilization patterns, national normative data, CMS and CCI initiatives, OIG work plans and advisories and healthcare industry best practices.
Develops compliance training content and provides one-on-one and group training to faculty physicians, advanced practitioners, billing and coding staff and others to ensure compliance with federal and state regulations and laws, CMS and other third‑party payer billing rules and internal documentation, coding, and billing policies and procedures.
Researches, abstracts and communicates federal, state and payer documentation, billing and coding rules and regulations; stays current with Medicare, Medicaid and other third‑party rules and regulations, CPT and ICD coding updates; serves as institutional subject matter expert and authoritative resource in these areas.
Qualifications
Bachelor's degree in Health Information Management, Business, or other relevant field; in lieu of a Bachelor's Degree, a High School Diploma/GED and 4 additional years directly related work experience for a total of 9 years directly related work may be considered.
CPC or CCS‑P, or other applicable AAPC or AHIMA credential.
Five (5) years' experience in Evaluation and Management coding and auditing or related work.
Knowledge of Medicare and Medicaid documentation and coding rules and guidelines; ICD/CPT/HCPCH/DRG/APC documentation coding rules; teaching physician guidelines; charge capture and reimbursement methodologies; E/M rules; medical terminology; healthcare compliance audit methodology, principles and techniques; CMS manuals; professional services reimbursement and repayment; confidentiality standards.
Ability to interpret and apply documentation and coding rules and regulations and to interpret medical records progress notes, handwritten and electronic chart entries, provider orders and other related documentation.
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