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Compliance Auditor

2131 South 17Th Street
Wilmington, NC

Date Posted: Aug 25, 2020

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Job Description

Description

About NHRMC

NHRMC, established in 1967 in Wilmington, NC, is recognized as a preeminent healthcare organization focused on leading our community to outstanding health. We have an 855 bed network of hospitals and multi-specialty physician group practices with more than 200 physicians. With a network of primary, specialty, neighborhood clinics and regional medical centers; you will find our culture is the very definition of best in practice. Join us and find out how many ways NHRMC offers you the chance to focus on what really matters - our patients and community.

About the Job

Location: New Hanover Regional Medical Center

Department: Corporate Compliance

Full Time Equivalent: FTE: 1.000000

Work Type: 64 to 80 Hours Pay Period

Work Schedule: STD HRS - Standard-Exe or Office w flex

Exempt from Overtime: Exempt: Yes

What You'll Do

Summary:
The Compliance Auditor will develop audit programs for claims processing and business operations to ensure compliance with federal and state law requirements. This includes Federal requirements during patient registration, billing compliance for the 340B drug program, physician contracts, as well as billing compliance for radiology, pharmacy, and other ancillary service lines.
The Compliance Auditor will facilitate the annual compliance risk assessment and lead in the development of annual compliance work plans for NHRMC and PMH.
The Compliance Auditor will assess risks, identify trends, develop and execute appropriate tests of controls, present results and recommendations for improvements to management, and prepare audit reports.
Additionally, the Compliance Auditor conducts follow up and investigations on incident reports regarding patient privacy or security concerns and/or suspicious access identified. Under the leadership of the Compliance/Privacy Officer, the scope of the Compliance Auditor's role includes New Hanover Regional Medical Center, Pender Memorial Hospital, NHRMC Home Care, and the NHRMC Physician Group.
Under the oversight of the Compliance/Privacy Officer, the Compliance Auditor develops fiscal year Corporate Compliance Education Plan and delivers initial and ongoing compliance and privacy training to the workforce.
The Compliance Auditor will liaison with ancillary departments, Legal Affairs, Fiscal Service, Patient Financial Services, Patient Access Services, Revenue Recovery, Reimbursement, Health Information Management, and other departments and external parties to assure accurate claims submission.


Responsibilities:
1. The Compliance Auditor will work with multiple departments in the hospital to audit and/or evaluate compliance with federal and state rules and regulations.
2. The Compliance Auditor will track outstanding issues identified in compliance audits and issue reports and appropriate recommendations and/or conclusions to the Compliance/Privacy Officer, department leaders, and the Corporate Compliance Committee.
3. The Compliance Auditor will assist in the development, execution and follow-up of action plans, education to improve performance, and apply LEAN methodologies, as applicable.
4. The Compliance Auditor facilitates the annual compliance risk assessment process and leads the develop of annual compliance work plans for NHRMC and PMH. The Compliance Auditor ensures timely completion of all audit tasks assigned.
5. The Compliance Auditor will track, investigate, manage, and mitigate HIPAA Privacy incidents involving inappropriate access and disclosure of protected health information, complaints or breaches, including, but not limited to the coordination of investigations with leadership of respective departments. She/he will ensure all reports required under applicable privacy laws and regulations are completed and submitted in a compliant and timely manner, under the direction of the Compliance/Privacy Officer.
6. The Compliance Auditor will develop and conduct ongoing privacy and compliance training to the workforce, as well as promote activities to foster information privacy awareness within the organization, such as privacy assessments, tracers, newsletters, etc.
7. The Compliance Auditor will gather and report on specified financial and operational data as determined by the Compliance Officer for Compliance Program Work Plan audits, compliance tracer activities, and tracking and trending predefined Compliance data/ dashboard indicators.
8. The Compliance Auditor will compile, report and trend external agency Compliance concerns and requests, and perform investigations under the direction of the Compliance Officer
9. The Compliance Auditor serves as a resource for the organization regarding corporate compliance and privacy, acting under the direction of the Compliance/Privacy Officer.
10. The Compliance Auditor will participate in applicable compliance-related work teams and committees.

Position Requirements

Credentials:

Education:
Essential:
* Bachelors Degree

Other information:
Experience: At least 5 years recent experience in auditing, claims processing, business management or hospital operations. Demonstrates standards of performance (ownership, teamwork, communication, compassion) that support patient satisfaction and principles of service excellence.
Performs other duties as assigned.
Individual will possess commensurate combination of education, experience and qualifications.

Other Information

This position description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications which may be required of the employee assigned to the position. Depending on the location of the job, duties may vary. Receipt of the job description does not imply nor create a promise of employment, nor an employment contract of any kind; my employment with the Company is at will.

  • Member Top 100 Hospitals – In 2016 NHRMC was recognized as a Top 100 Hospital demonstrating significant investment and financial sustainability for the communities we serve. 
  • Newsweek's 2020 list of Best Maternity Care Hospitals - NHRMC Betty H. Cameron Women's & Children's Hospital was named as a Best Maternity Care Hospital by Newsweek. 
  • Forbes America’s Best Large Employers 2018 and 2019Link 
  • Becker’s 150 Top Places to Work in HealthcareLink 
  • Healthgrades Outstanding Patient Experience

Consider a career at NHRMC and become part of this award winning team!

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