At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.
Job Summary
Position is responsible for leading multiple reviews / audits of healthcare coding, billing, documentation, operations, and related risk areas to support compliance with regulatory standards, internal policies and procedures, and other guidelines. Typically reports to Director, Corporate Compliance.Job Description- The ideal candidate is an healthcare auditor with a minimum of 7 years auditing experience
Education: High school diploma or GED required. Bachelor's in healthcare-related field (Healthcare Administration, Health Information Management, Nursing, etc.), business, or other equivalent area preferred.
Licenses/Certifications: A certification in one of the following:
Certified Coding Specialist (CCS), or
Certified Inpatient Coder (CIC), or
Certified Professional Coder (CPC), or
Certified Professional Medical Record Auditor (CMPA), or
Certified Professional Compliance Officer (CPCO), or
Certified in Healthcare Compliance (CHC), or
Certified Healthcare Auditor (CHA), or
Registered Heath Information Technician (RHIT), or
Registered Health Information Administrator (RHIA), or
Other equivalent professional certification.
Experience / Knowledge / Skills:
Seven (7) years of relevant experience in compliance, auditing, healthcare coding or billing (hospital or physician), healthcare operations, clinical documentation, consulting, or other equivalent area.
Two (2) years of experience in the healthcare industry is preferred.
Knowledge of healthcare coding principles and standards (International Classification of Diseases, 10th Revision (ICD-10-CM/PCS), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), etc.) and healthcare reimbursement practices, including billing and documentation requirements.
Knowledge of electronic medical record (EMR) and imaging systems, with EPIC experience preferred.
Strong project management and organization skills, including the ability to prioritize to meet deadlines, manage multiple projects simultaneously, and proactively communicate with leadership and stakeholders.
Ability to analyze and interpret complex regulations, rules, and requirements.
Strong analytical and problem solving skills, including the ability to obtain and analyze data and think critically when evaluating problems and making decisions.
Ability to work independently with strong attention to detail and accuracy.
Strong customer service and interpersonal skills, including the ability to interact with and build relationships with individuals at all levels of the organization.
Effective oral and written communication skills, including the ability to create written reports and deliver oral presentations.
Proficient computer skills, including Word, Excel, and PowerPoint.
PRINCIPAL ACCOUNTABILITIES
Leads multiple Corporate Compliance reviews / audits of healthcare coding, billing, documentation, operations, and related areas (e.g., coding assignments, charge capture, clinical documentation, claim submissions, etc.) from planning through completion.
Develops methods and strategies for monitoring and evaluating the integrity of organization processes and systems.
Leads Corporate Compliance risk assessment processes and activities, including evaluating enterprise-wide clinical, business, and operational areas for compliance risks, internal control deficiencies, and potential fraud, waste, and abuse.
Directly accountable for identifying and recommending corrective actions and influencing enterprise-wide practices, outcomes, and process improvements.
Acts as an organizational-level subject matter expert for healthcare regulatory requirements and coding standards (International Classification of Diseases, 10th Revision (ICD-10-CM/PCS), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), etc.), including advising organizational stakeholders on these areas.
Directly accountable for preparing detailed written reports and presentations, and communicating review findings orally and in writing to executive leadership and various System-level committees.
Takes the lead on responding to compliance inquiries and guidance requests from across the organization, and conducts compliance investigations and special reviews.
Directly accountable for researching, interpreting, and advising the organization on the regulations, rules, and requirements issued by government agencies and other oversight authorities (Centers for Medicare & Medicaid Services (CMS), U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), etc.).
Maintains knowledge of current compliance requirements, including healthcare coding, billing and documentation standards and government (Medicare, Medicaid, etc.) and managed care requirements.
Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency, supports department-based goals which contribute to the success of the organization, and serves as preceptor, mentor and resource to less experienced staff.
Ensures safe care to patients, staff and visitors, adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards of providing safe, caring, personalized and efficient experiences to patients and our workforce.
Other duties as assigned.
Skills Required
- Minimum 7 years auditing experience
- Bachelor's in healthcare-related field or equivalent
- Certification in healthcare coding or compliance (e.g., CCS, CPC)
- Strong knowledge of healthcare coding principles and regulations
- Two years of experience in the healthcare industry preferred
What We Do
At Memorial Hermann, we are all about advancing health. Yours. It begins by redefining healthcare. Our 6,400 affiliated physicians and more than 26,000 employees practice evidence-based medicine with a relentless focus on quality, safety and exceptional service for all patients, consumers and Health Plan members. Our efforts continue to result in national awards and recognition, including for our nationally acclaimed Accountable Care Organization. With a focus on providing enhanced access to care, Memorial Hermann offers Virtual Clinic for digital access and has 300 care delivery sites conveniently located across the Greater Houston area, including our flagship hospital in the world-renowned Texas Medical Center, which serves as the teaching hospital for McGovern Medical School at UTHealth. We have proudly served this community for more than 110 years, and we contribute more than $588 million annually through school-based health centers and other community benefit programs. Because at Memorial Hermann, the health of our community is always at the center of what we do. Learn more about Memorial Hermann Health System.
