Compliance Auditor Non Coding
Job Title: Compliance Auditor Non-Coding
Date Posted: 11/10/16
Location: Allegheny Health Network Corporate Office
Position Number: 54101
Allegheny Health Network is an integrated delivery network focused on preserving health care choice and providing affordable, high-quality care to the people in our communities. With more than 14,000 employees including 7,400 health care professionals, nearly 200 primary care and specialty care practices, Allegheny Health Network includes seven hospitals in Pennsylvania with nearly 2,400 licensed beds.
Allegheny Health Network’s clinical expertise ranges from primary care to the most complex surgical procedures. Services include cancer diagnosis and treatment, cardiovascular care, neurological and neurosurgical services, organ transplantation, orthopedic and rehabilitation services, and women’s health.
Status: Full-time
Non-Union Position
Job Summary: Manages general non coding compliance activities including: physician contract, stipend, payment, lease review in accordance with Stark requirement. Conducts and documents special investigations related to management concerns or hotline calls and auditing of provider based clinics. Manages general compliance project activities such as the sanction check process, vendor relations, RAC data, sunshine act and data mining activities.
Job Responsibilities:
- Manages general non coding compliance activities including: provider based clinics, physician contract, stipend, payment, lease review in accordance with Stark requirements.
- Prepares reports, corrective actions as needed.
- Provides education to management and physicians on these topics based on audit results.
- Conducts and documents special compliance investigations related to internal or external concerns/hotline calls.
- Compiles supporting documentation detailing results and proposed action plans to address potential areas of improvement and/or non-compliance.
- Manages non coding compliance activities such as sanction checks, physician sunshine act and the generation of data mining activities.
- Performs other duties as assigned or required.
Education: Bachelor's degree or equivalent education and experience.
Licensure/Certification/Registration: Current Driver's license as car and travel throughout Western PA is required.
Complexity of Work: Communicates effectively both orally and in writing. Completes duties and assignments independently while working effectively under deadline situations. Identifies problems and effectively problem solves. Performs functions under minimal supervision and conducts research on current and/or pending regulations. Works on several projects concurrently. Regularly informs the Director of work progress relating to assigned audits/investigations/projects and seeks advice or consultation regarding issues or problem areas. Seeks direction from Corporate Director of Compliance for non-routine activities.
Required Experience: Minimum of 5 years experience with compliance or auditing related work such as conducting audits, investigations, working with compliance related regulations and providing education to physicians and management or graduate of law school with 1 year working as an attorney with experience reviewing contracts. Strong understanding of systems and data analytics. Experience analyzing data and investigating situations with the ability to formulate recommendations and/or advice with minimal oversight. Prior supervisory experience preferred. Advanced computer skills in applications such as Microsoft Word, Excel and PowerPoint. Proficient writing skills, preparation of reports and ability to present clear and concise findings (oral and written). Possesses the skill sets and expertise to identify aberrant trends/practices, interpret policies and be prepared to justify decisions or options.