Clinical Compliance Auditor

at  Encompass Health

ABOUT US

As a national leader in post-acute care, Encompass Health (NYSE: EHC) offers facility-based patient care through its network of inpatient rehabilitation hospitals. With a national footprint that spans 157 hospitals in 37 states and Puerto Rico, the Company is committed to delivering high-quality, cost-effective rehabilitation. Encompass Health has been ranked by Modern Healthcare as a Best Place to Work, and our Home Office is consistently rated a Best Place to Work by the Birmingham Business Journal.

QUALIFICATIONS

License or Certification:

• RN licensure required

Minimum Qualifications:

• Minimum four years of experience with inpatient and/or outpatient rehab preferred
• Associate’s or Bachelor’s degree in nursing or other clinical degree preferred
• Master’s degree in nursing or other clinical degree desirable
• Knowledge of health care regulations and clinical terminology is required
• Knowledge of governmental reimbursement laws and regulations preferred
• Working knowledge of auditing techniques and auditing standards required
• Strong PC literacy (Microsoft Word and Excel, email)

RESPONSIBILITIES AND TASKS

• Assists Compliance Audit Manager and Senior Compliance Auditor in planning activities.
• Participates in preparing audit programs based upon the defined objectives.
• Executes/records audit procedures in accordance with Compliance Audit work paper standards.
• Identifies and prioritizes potential exceptions, exposures and opportunities for management review.
• Works with client management and staff to obtain concurrence on issues and recommendations.
• Knows detailed responsibilities required of position.
• Keeps updated and current (regulations, guidance, etc.).
• Understands and utilizes the company resource structure.
• Develops strategies and aligns work to achieve goals.
• Completes special projects and other duties as requested to support needs of organization.
• Networks with co-workers to share best practices.
• Actively participates in the creation/modification of policies and procedures.
• Organizes, plans, and manages time effectively to complete assignments.
• Completes mandatory training and courses required by completion date.
• Reports questionable situations, concerns, complaints or harassment immediately.
• Understands the role of key performance indicators as they relate to areas under audit.
• Develops accurate time budget/ forecast.
• Implements and ensures audit work conforms to professional coding standards.
• Bases audit findings on systematic analyses and effect of decisions on all areas of the company.
• Uses facts/data to completely understand the situation; negotiates mutually-acceptable resolutions.
• Participates in the follow-up process to ensure resolution of audit findings.
• Interprets the relative significance of issues needing resolution; escalates at appropriate time.
• Efficiently plans, manages and audits to minimize resources in audited departments.
• Works with Compliance Audit to develop regulatory audit plan/programs/procedures/standards.
• Formulates audit programs to test current procedures; prepares to document audit tests.
• Audits medical records and billing practices to monitor compliance with applicable regulations.
• Prepares audits, studies, and other findings for the Compliance Audit Department.
• Utilizes resources to effectively and successfully execute responsibilities of the position.
• Completes outpatient billing audit and other audits requiring clinical and/or coding expertise.