Title: Audit Coordinator
At White Plains Hospital, you have an opportunity to work side-by-side with some of the most talented people in the world.
We have been widely recognized for our exceptional culture, world-class physicians, Magnet designated nurses and passionate employees who make a real difference in our community. With tremendous growth opportunities, great benefits, and flexible work schedules, it is no wonder why we are consistently recognized a Great Place To Work.
Position Summary
Coordinate requests for documentation from various external and internal sources, including commercial payers, RAC, ADR, and CERT, Pre-Pay Probes, NGS and any other governmental or nongovernmental agency, as well as any internal audit request. This role acts as a liaison to maintain cooperative working relationships with various internal and external customers. Manages and maintains the current audit tracking system. Responsible for providing education to internal department staff and to other departments throughout the hospital regarding audit results to ensure compliance with government standards. Responsible for tracking and reporting on current audit activity as well as financial exposure to the executive management team. After audits are concluded, it is responsible to report out to the executive team action plan to ensure that there is no future exposure based upon audit results. Trends to resolve root causes to minimize future risk and revenue loss. Up to date with all billing rules and regulations assuring proper charging and billing. Ensure billing edits related to compliance issues are resolved timely and effectively. Requires constant awareness of updates and changes to Medicare and Medicaid; assures all information is disseminated to appropriate staff and departments.
Essential Functions and Responsibilities Include the Following:
1. Understands and adheres to the WPH Performance Standards, Policies and Behaviors.
2. Receives, coordinates, and ensures all audit requests are processed under specified time frames.
3. Responsible for maintaining the current audit system and updating any new information as well as tracking audit requests within the system until completion
4. Develop plans of action based upon audit results/findings to ensure compliant charging and billing in line with government regulations and monitor resolution, frequently involving ancillary departments.
5. Assists with SPARCS error review and report log.
6. Stay abreast of all changes based on Medicare and Medicaid regulations and billing protocols, including weekly review of governmental websites.
7. Responsible for trending to resolve root causes associated with audits to minimize future revenue loss and risk.
8. Establishes corrective action plan and work groups to minimize future audit risk and review outstanding audit issues
9. Report out to management and senior leadership on all current audit activity, progress on open audits as well as summaries of work group initiatives and action items.
10. Responsible for identifying and alerting management of any compliance, build up, or process problems in revenue cycle flow
11. Responsible for facilitating government audits with business office and other affiliate departments
12. Responsible for reporting audit findings, risks and results to Risk Management
13. Track, monitor and maintain government audits and nongovernmental audits to include CMS, RAC, MIC, OIG, managed care audits and various other governmental audits
14. Perform regular internal audits, coordinating with departments and external contacts to assess risk and develop action plans to minimize and prevent
15. Clear understanding of systems utilized for audits.
16. The person in this position will be required to frequently communicate with outside departments and governmental agencies and must be able to exchange accurate information in these situations.
Education & Experience Requirements
Three to five years of working with and understanding of Medicare and Medicaid billing processes and interpretation of billing guidelines, as well as knowledge of medical terminology and coding conventions are required.
Hospital Billing Office experience required.
Minimum education requirement Associates/bachelor’s degree in business, Management, or Health Related Fields preferred.
Epic experience is a plus.
Core Competencies
The ability to set priorities, establish processes and create monitoring tools, self-initiator and self-motivator.
Strong organizational and communication skills. Proactive approach to problem anticipation and solving.
Strong PC software
Skills: ability to grasp hospital-based billing software systems to maximize system utilization.
The responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of White Plains Hospital.