Adeptus Health

  • Clinical Auditor & Compliance Analyst

    Job Location US-TX-Irving
    Posted Date 4 months ago(3/20/2018 5:42 PM)
    Type
    Regular Full-Time
    Job ID
    12050
    Shift
    Day
    Facility
    Corporate
    Company
    Adeptus Health - Corporate
  • Company Overview

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    About Adeptus Health

    Adeptus Health is a leading patient-centered healthcare organization expanding access to the highest quality emergency medical care through its network of freestanding emergency rooms and partnerships with premier healthcare providers. All Adeptus Health freestanding facilities are fully equipped emergency rooms with a complete radiology suite of diagnostic technology, on-site laboratory, and staffed with board-certified physicians and emergency trained registered nurses. For the last four years, Adeptus Health has exceeded the 95th percentile in patient satisfaction according to patient feedback collected nationwide by Press Ganey Associates Inc. Adeptus Health also was named a 2016 and 2017 Best Workplaces in Healthcare by Great Place to Work® and Fortune Magazine.  For more information, please visit adpt.com.

    Responsibilities

    The Clinical Auditor and Compliance Analyst manages and performs financial, operational, process, fraud, clinical and compliance audits for the company. This incorporates a wide array of businesses that includes hospitals, physician staffing, and free standing outpatient emergency services. This individual is responsible for establishing and maintaining a collaborative and consultative relationship with management, staff, and physicians. Maintains all organizational and professional ethical standards and completes all internal audit work in compliance. Works under limited supervision with moderate latitude for initiative and independent judgment.


    Job Responsibilities and Duties
    Essential Job Functions:
    • Perform risk assessments of internal audit and compliance issues
    • Assist in the development of the annual internal audit and compliance schedule and work plans
    • Establishes and maintains effective communication and interpersonal skills to contribute to a positive work environment
    • Perform analysis for operations, management studies, contracts, financial reviews and internal controls
    • Manage and conduct internal audits and compliance audits and follow-up reviews
    • Determines priorities in workload and completes projects in an accurate and timely manner
    • Prepare accurate and timely audit reports and ensure that the internal audit and compliance work papers meet internal auditing standards
    • Participate in the development and revision of the internal audit and compliance policies and procedures
    • Maintains current awareness of internal audit and Compliance regulations and of industry developments pertaining to reimbursement, federal and state laws and coding and billing guidelines
    • Pursues professional development opportunities, including internal and external training and professional association memberships and shares information gained with co-workers
    • Benchmarks audit and compliance work processes and promotes continuous process improvement
    • Works closely with the Compliance team to ensure corrective actions are implemented, including payer refunds and adjustments
    • Provide analysis and acts as a corporate liaison to support the inquiries of the market compliance committees and other oversight processes established to ensure an open and efficient market operation
    • Support and participate in the analysis of random compliance audits or specific compliance audits of alleged “non-compliant” market practices and present findings to the compliance committee with recommendations for actions to be taken
    • Conduct compliance monitoring
    • Provide analytical support to the development and maintenance of market compliance standards and practices
    • Participate in maintaining a highly secure and protected compliance information system that supports the monitoring and compliance enforcement functions
    • Ensuring all policies and procedures are implemented and well documented.
    • Perform occasional internal reviews
    • Identify compliance problems that call for formal attention
    • Develop risk management strategies to avoid non-compliance reports and regulatory bodies
    • Review compliance manuals, materials and policies to ensure accuracy and completeness with all rules and regulations
    • Stay abreast of trends in the legal/regulatory environments and assess impact to the organization
    • Helps coordinate, take minutes, and perform all necessary follow-up for the corporate compliance committee
    • Ability to travel to markets up to 25% annually

     

    Supervisory Responsibility:
    None

     

    Other Duties:
    Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

     

    Competencies
    • Energetic team player
    • Strong problem-solving and decision making skills
    • Confident self-starter with positive attitude and drive
    • Ability to multi-task and consistently meet deadlines
    • Innovator/thought leader – Ability to look through challenges to identify opportunities
    • Strong organizational skills
    • Demonstrate competent administrative and leadership skills
    • Must possess ability to prioritize responsibilities and handle multiple projects simultaneously
    • Possess the ability to deal tactfully with all types of personnel, medical staff and the public

    Qualifications

    Education and Experience:

    • Minimum Bachelor’s degree
    • Registered Nurse
    • A minimum of two years compliance preferably in the healthcare industry
    • Strong objective, analytical skills with a high emphasis on quantitative analysis
    • Demonstrate strong reporting and data validation experience
    • Experience in legal practices of discovery and case development, litigation support and performance auditing
    • Strong project management skills; proven ability to effectively manage multiple, concurrent, cross-functional areas of a project or projects
    • Demonstrated ability to learn quickly, manage multiple projects and drive/achieve results, while working with minimal direction

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