Audit & Onboard Specialist- Remote | BomaLink

Audit & Onboard Specialist- Remote

Finance and Accounting

Posted 9 months ago

Details

JOB SUMMARY
The Audit and Onboarding Specialist is responsible for planning, coordinating and completing complex compliance reviews of billing and documentation activities for The Methodist Hospital Physician Organization (PO) departments. The Specialist follows departmental policies and procedures as well as basic instructions in carrying out daily tasks. The incumbent will serve as a liaison between PO CBO, PO Departments and community providers and provide direction and guidance to department-level coders and clinical providers. The Specialist is also responsible for ensuring successful onboarding of physicians in regards to compliance in clinical documentation and coding.
 
This position can work remotley in the Houston Metropalitan Area
DUTIES AND RESPONSIBILITIES

People 20%

  • Recommends and/or takes corrective action after communicating with department coders
  • Provides guidance to other PO CBO staff to ensure consistency in communication and practice and to foster professional development. Assists department and/or PO CBO in communicating physician billing compliance issues.


Finance 20%

  • Audits and reconciles services and items included in the patient's chart with services and items included on the patient's bill in a timely manner
  • Provides business practices billing compliance departmental management with status reports of progress against the annual monitoring and assessment plan and other goals such as cycle time targets
  • Analyzes data/reports from compliance monitoring activities to identify trends, issues, and risk areas. Identifies opportunities for improvement and develop formal monitoring recommendations that are value-added and cost-effective


Quality/Safety 25%

  • Collaborates with the PO CBO to communicate audit results. Delivers a list of exceptions needing corrective action based on audit results.
  • Performs audits of billed claims' optimal reimbursement and identifies areas that represent a high risk with respect to compliance issues
  • Determines the effectiveness and efficiency of billing compliance functions for departments
  • Designs, delivers, and assesses educational materials for use in physician/staff training modalities. Participates in revenue cycle meetings.
  • Monitors provider progress as directed by management to ensure adherence to regulations and policies and procedures
  • Coordinates the physician onboarding process to ensure physician compliance and competency in following PO policies and procedures. Communicates any necessary risks in a timely manner.


Service 10%

  • Provides quality assurance, direction and guidance to PO departments
  • Demonstrates the components of the ICARE values Statement
  • Demonstrates the components of The Houston Methodist Experience Service Standards and translates them into specific expectations of staff to anticipate and meet customer service needs
  • Ensures protection of private health and personal information. Adheres to all HIPAA and PCI compliance regulations.


Growth/Innovation 25%

    • Demonstrates industry, billing compliance knowledge, skills and abilities in the review of E/M and procedural coding assessment, auditing, reporting and follow-up processes; capable of handling moderately complex healthcare review projects with minimal supervision
    • Assists in writing policies, protocols and procedures to address billing compliance and documentation issues; including drafting and working with others to edit and to adopt.
 
EDUCATION REQUIREMENTS
Associate's degree; Bachelor's degree in healthcare, business or related field, preferred
 
EXPERIENCE REQUIREMENTS
5 years prior relevant auditing experience with another healthcare entity preferably in a professional/physician environment, with at least 3 years experience in an academic setting.
 
CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED
Active certification from AAPC or AHIMA
 
SPECIAL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
    • Demonstrated project management skills - proven ability to work under pressure and multi-task competing priorities within established time constraints
    • Proficient in spreadsheet, word-processing, presentation, and compliance tracking software, as well as Internet Healthcare regulatory websites. Knowledge of healthcare billing and PATH guidelines.
    • Demonstrates effective verbal and written communication skills. Proven presentation skills to a variety of audiences.
    • Demonstrates a positive, helpful and supportive attitude and demeanor
    • Professional handling of exposure to confidential/sensitive information requires strict confidentiality with no compromise, as well as honesty and integrity
    • Proven ability to analyze information and situations and to identify issues
    • Must be able to deal with difficult issues, maintain objectivity, use good judgment, and envision outcomes when making decisions
    • Understands and can define the global impact of the revenue cycle function
    • Ability to analyze, identify and articulate identified trends and report trends succinctly in a clear and concise manner
    • Ability to multi-task in a fast paced environment, prioritize projects and work independently with attention to detail
    • Must be a self-motivated individual with the ability to think critically and work independently
    • Performs at a level requiring minimal direct supervision
 

Company Profile:

Houston Methodist Specialty Physician Group - As one of the nation’s leading hospitals and academic medical centers Houston Methodist has brought together some of the nation’s leading experts in multiple specialties to serve our patients. As part of Houston Methodist Specialty Physician Group (HMSPG), these specialists not only provide excellent clinical care, but are on the forefront of research, developing leading-edge technologies and treatments, and teaching the medical pioneers of tomorrow. This combination of clinical service, research and academics ensures patients have access to the latest in treatments and technologies while providing the best in comprehensive patient care. Established as a non-profit corporation and certified by the Texas State Board of Medical Examiners, HMSPG enables physicians to maintain autonomy with respect to their clinical practice while growing their practice within an academic environment.


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