To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
The Receivable Integrity QA Audit Specialist oversees related audit and review activity with Internal Audit, Corporate Compliance, Independent Auditors, and Insurance auditors for all of Corporate Business Services (CBS) for hospital billing and Corporate Professional Business Services (CPBS) for professional billing. Assists with activities related to the development, implementation, and maintenance of internal compliance programs consistent with regulatory requirements for both Hospital Billing (HB) and Professional Billing (PB) within the Health System. Coordinates, evaluates, and assesses impact of implementing all audit findings related to financial and insurance audits and provides feedback to management team regarding the audit recommendations on the accounts receivable operation ensuring audit management responses are effective. Assigns and takes lead responsibility for Internal Control narratives, risk assessments and control reviews. Also responsible for analyzing and reporting on areas of exposure relating to Internal Controls while identifying newer risks along with the implementation of new controls within the System Business Office (HB and PB), Access, Pre Service, and HIM. Responds to inquiries, investigates complaints, prepares audit reports, recommends and monitors completion of education related to QA and audit findings, maintains audit records, and monitors regulatory developments. Leads other QA tasks as assigned by Senior Manager. Ensures that all record keeping and information disbursement complies with HIPAA regulations.
- 1. Assists with the implementation and maintenance of internal compliance program consistent with the organization's compliance plan and regulatory requirements.
- 2. Coordinates audit activities for CBS and CPBS (HB & PB) operational departments. Ensures management responses are completed timely and reflect optimal, efficient outcomes.
- 3. Prepares summary reports of audit findings/results to ensure effective communication to CBS leadership. Reporting should contain specific recommendations for improvement, corrective actions, and timeframes for completion as well as dates for planned follow up.
- 4. Provides members of the team assistance on more complex audits and challenging remediation plans.
- 5. Monitors teams efforts related to audit follow up and remediation plan testing.
- 6. Takes the lead on coordinating tasks for the team for Enhanced Business Practice (EBP) internal control reviews. Recommends plans and schedule for annual control testing; monitors team?s compliance to schedule; and communicates potential shortfalls to Sr. Manager.
- 7. Provides guidance to Business Practice Auditors. Assists with oversight and delivery of initial and ongoing training and orientation to all employees, contractors, alliances, business associates, and other appropriate third parties on regulatory requirements.
- 8. Develops standard compliance reports to communicate findings on trends. Provides reports on these activities to the Sr. Manager.
- 9. Represents team at various inter-departmental meetings and serves as a conduit for team communication. Actively participates in meetings and/or seminars and disseminates the information to peers and staff to enhance the knowledge and skills of the department and organization.
- 10. Assists in the identification, implementation, and revision of operational departmental procedures related to audit findings, internal controls or other QA initiatives.
- 11. Takes the lead on various QA Optimization projects and coordinates team's activities to complete the QA review and recommendations for workflow improvements as directed by Senior Manager.
- 12. Participates and/or leads cross-functional workgroups and meetings to achieve overall corporate compliance objectives.
- 13. Maintains current knowledge of applicable federal and state laws and accreditation standards, and monitors advancements in information technologies to ensure organizational adaptation and compliance.
- 14. Develops effective relationships with all affected departments through exemplary customer relations and utilizing motivational methods to ensure that all parties respond in an accurate and timely manner to audit findings and / or the need to initiate and implement revised operational procedures.
- 15. Perform other duties as may be assigned.
Bachelor's degree in Healthcare/Finance with operational work experience in a hospital accounts receivable environment or experience with operational auditing. Master of Business Administration preferred.
Three (3) to five (5) years' experience in related Healthcare/Finance field with experience in patient accounting issues, development/monitoring of internal control procedures, quality assurance programs and audits. Experience should include audit reviews including regulatory and healthcare compliance as well as quality assurance reviews.
Comprehensive knowledge of federal and state healthcare regulations relating to documentation, billing and coding. Ability to interpret healthcare regulations, departmental policies and operational procedures and make recommendations for improvements. Strong critical thinking and data analysis abilities including the ability to gather information from multiple sources in order to gain a thorough understanding of problems/issues. Demonstrated attention to detail. Ability to effectively lead and manage projects. Ability to interpret and analyze data/documentation. Interpersonal/Communication/Relationships -- builds effective working relationships and treats others with respect. Ability to work in a continuously changing environment, flexible. Excellent written and verbal communication skills, including ability to present findings and recommendations as required.