Primary City/State:
Arizona, Arizona
Department Name:
Compliance-Corp
Work Shift:
Day
Job Category:
Compliance
Great careers are built at Banner Health. There’s more to health care than doctors and nurses. We support all staff members as they find the path that’s right for them. Apply today, this could be the perfect opportunity for you.
Becker’s Healthcare recently honored Banner as one of 150 top places to work in health care for 2023, we are proud to offer our team members many career and lifestyle choices throughout our network of facilities. At Banner Health, we’re excited about what the future holds for health care. That’s why we’re changing the industry to make the experience the best it can be. If you’re ready to change lives, we want to hear from you.
The role is Monday - Friday 8 AM - 5PM, the location is remote and the team is open to out of state candidates but would like their team to be available to be onsite once per quarter. In this role you will be responsible for managing audits, mentoring staff, and managing reporting for all Banner plans and networks. If you have audit experience with knowledge in health plans and healthcare this would be an ideal role for you!
Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefits.
Within 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.
POSITION SUMMARY
This 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 coding, billing and other business procedure audits and prepares and presents reports of findings at the direction of compliance leadership. 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 organization’s 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.
CORE FUNCTIONS
1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. Assumes additional responsibilities to assist and support the organization's compliance program often dealing with complex and unique situations and problems.
7. Performs job functions on a system-wide basis. Internal and external customers include, but are not limited to, executives and managers, compliance committees, physicians and clinical staff. Must maintain relevant professional licensure/certification.
MINIMUM QUALIFICATIONS
Requires 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 two to three years of payer, clinical or healthcare operations experience and/or three to five years of 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 QUALIFICATIONS
Relevant 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.
EOE/Female/Minority/Disability/Veterans
Our organization supports a drug-free work environment.
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