Banner Boswell Medical Center
Banner Health is currently seeking a Compliance Audit Senior Consultant to join the Ethics & Compliance Department. This position is located at Banner Corporate Center Phoenix Plaza, off Central & Thomas.
The Ethics & Compliance Department is responsible for developing, implementing, and overseeing all aspects of Banner's Corporate Compliance Program. This includes compliance personnel, compliance documents, compliance training and education, reporting and investigating compliance matters, monitoring and auditing to identify and reduce compliance violations, preventing and responding to allegations of improper or illegal activities, and enforcing compliance and disciplining non-compliance.
About Banner Health CorporateWithin Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care.
About Banner HealthBanner Health is one of the largest, nonprofit health care systems in the country and the leading nonprofit provider of hospital services in all the communities we serve. Throughout our network of hospitals, primary care health centers, research centers, labs, physician practices and more, our skilled and compassionate professionals use the latest technology to make health care easier, so life can be better. The many locations, career opportunities, and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee.
Job SummaryThis position conducts scheduled audits defined in the annual audit plan, as well as, requested unplanned audits resulting from an internal request or a government investigation. Plans, coordinates and manages audits and third party investigations under the direction of compliance leadership. Conducts high level complex clinical, medical necessity, coding, billing and other business procedure audits and prepares and presents reports of findings at the direction of compliance leadership. Perform at a high level of expertise demonstrating comprehensive regulatory knowledge and project management skills. Acts as a liaison to operational and clinical departments regarding compliance regulatory issues. Assists with the development of corrective actions and monitoring activities to mitigate risk and validate ongoing compliance with government regulatory requirements. Conducts internal investigations reported though the compliance/ethics line as applicable, assists the organizations compliance officers as directed to research and investigate concerns or questions related to compliance or regulatory requirements. Provides support to compliance leadership during government investigations, including document indexing, medical record review, research regarding applicable laws and regulatory requirements, internal policies, procedures/operational processes and maintaining investigation file integrity.
Researches regulatory requirements relative to assigned audits and develops audit tools. Conducts audits utilizing defined audit standards, communicates the audit process through a pre-audit conference, identifies areas of potential risk, prepares audit reports, communicates results though an audit exit conference, assists in the development of corrective action plans, monitors effectiveness of corrective action plans, and provides training if indicated.
Manages highly complex and sensitive questions, concerns and complaints related to compliance matters, providing answers and support t system, divisional, regional and facility leadership. Ensures that reasonable steps are taken to respond timely and appropriately to compliance issues and concerns.
In consultation with others in the Compliance and Legal Departments, manages Banners response to governmental or other third-party audits, investigations or inquiries. Works with system-wide groups and committees to develop policies or processes to address identified issues.
Supports the system, division, regional or facility compliance management staff by responding to questions or concerns, researching matters of note, providing training as necessary and developing processes and procedures to remediate concerns or issues.
Maintains awareness of laws and regulations and conducts research as needed to identify applicable laws, regulations and practices to maintain compliance. Reviews related policies and procedures and literature. Communicates applicable compliance issues to the compliance officers and assists in the distribution of training of such changes. Stay knowledgeable on current compliance-related laws and regulations through personal initiative, seminars, training programs and peer contact.
Identifies training opportunities based on audits, designs and presents such education to prevent repeated compliance risks at the direction of the compliance leadership team. Provides compliance/documentation education sessions to physicians and other staff.
Coordinates external investigation efforts in conjunction with the Banner Legal Department and Compliance leadership. Maintains investigation integrity by managing investigation files, reviewing applicable laws and regulations, Banner internal policies and relative operational processes.
Assists the organization's compliance leadership, as directed, to research and investigate complaints, concerns or questions relative to compliance issues. Investigates and follows up on reported issues as directed. Assumes additional responsibilities to assist and support the organization's compliance program often dealing with complex and unique situations and problems.
Minimum QualificationsRequires knowledge typically gained with completion of a bachelor's degree in business, nursing, internal audit or related field. Requires skills and abilities normally acquired with significant payer, clinical or healthcare operations experience and/or experience in medical coding or audit experience within a complex care or payer environment. Must be able to understand, apply and interpret complex rules and regulatory requirements in a variety of payer or provider settings and relevant healthcare-related government regulations, including Medicare and Medicaid. Requires clinical or payer knowledge, critical and analytical thinking skills to conduct compliance audits and draft reports. Written and verbal communication skills required. Computer skills in word processing and spreadsheets required. Ability to organize workload, manage multiple projects, and maintain confidentiality of all work information.Preferred QualificationsRelevant certification based on assigned area of focus. Experience in Payer or Healthcare operations, regulatory requirements, legal, revenue cycle, coding registered nurse (RN) or audit standards preferred as relevant to the position. Additional related education and/or experience preferred.
Banner Boswell Medical Center
Website : http://www.bannerhealth.com
We have more than 39,000 employees, making us one of the country’s largest employers as well. In fact, Banner Health is a leading nonprofit employer in every community we serve. In our Arizona Region, we are the state’s largest private employer, and we are one of Northern Colorado's largest employers.