We’ve made a lot of progress since opening the doors in 1942, but one thing has never changed - our commitment to serve, heal, lead, educate, and innovate. We believe that every award earned, every record broken and every patient helped is because of the dedicated employees who fill our hallways.
At Ochsner, whether you work with patients every day or support those who do, you are making a difference and that matters. Come make a difference at Ochsner Health and discover your future today!
This job assists with maintaining an effective auditing and compliance program. Independently completes assignments, manages projects, performs research, audits, and regulatory consultations; and ensures assignment objectives are achieved. Ensures that projects, coverage and services are completed as defined for areas of responsibility in the department’s annual plan and meet the needs of the Audit and Oversight Committee of the Board of Directors and executive management. Presents conclusions to department and organization management and educates and assists employees in applying and improving overall compliance and leads any assisting staff assigned to their projects.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential duties.
This job description is a summary of the primary duties and responsibilities of the job and position. It is not intended to be a comprehensive or all-inclusive listing of duties and responsibilities. Contents are subject to change at the company’s discretion.

EDUCATION

Required - High school diploma or equivalent.
Preferred - Bachelor’s degree in related field.

WORK EXPERIENCE

Required - 10 years of experience in coding, specialized coding, auditing, utilization management, or billing,
OR
6 years of experience in healthcare audit, compliance, or coding with a bachelor’s degree in related field.

KNOWLEDGE SKILLS AND ABILITIES (KSAS)

• Working knowledge of coding and billing regulations and medical necessity guidelines (which includes compliance with applicable laws and regulations), business risk, effective risk management techniques and auditing, and compliance’s role in corporate governance and its key relationships with the audit committee, board, and executive and operating management.
• Ability to translate compliance objectives and complex laws and regulations into easily understood concepts and then apply those concepts to a function or process and teach/instruct others on these matters.
• Proficiency in using computers, software, and web-based applications.
• Effective verbal and written communication skills and ability to present information clearly and professionally to varying levels of individuals throughout the required job processes.
• Effective interpersonal skills and ability to interact with individuals of diverse cultural backgrounds, ages, and all levels inside and outside the organization.
• Effective coaching, interviewing, and team-building skills.
• Good organizational and prioritization skills.
• Ability to gather information, understand problems, seeking out cause-and-effect relationships, identify underlying issues or problems, and reading and comprehend complex documents.
• Ability to function with the highest sense of integrity, exercising unprejudiced and unbiased judgment on behalf of the company’s welfare.
• Ability to travel across system.

• Independently completes clinical compliance audits.
• Reports audit findings and ensures development of corrective action plans.
• Independently manages the regulatory compliance audit appeals process.
• Coordinates the development and implementation of regulatory audit corrective action plans.
• Performs other related duties as required.
  The above statements describe the general nature and level of work only. They are not an exhaustive list of all required responsibilities, duties, and skills. Other duties may be added, or this description amended at any time.
  Remains knowledgeable on current federal, state and local laws, accreditation standards or regulatory agency requirements that apply to the assigned area of responsibility and ensures compliance with all such laws, regulations and standards.
  This employer maintains and complies with its Compliance & Privacy Program and Standards of Conduct, including the immediate reporting of any known or suspected unethical or questionable behaviors or conduct; patient/employee safety, patient privacy, and/or other compliance-related concerns.
  The employer is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status.