Compliance & Audit Partner

Overview

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Description

OVERVIEW:

Emory Healthcare (EHC) Office of Compliance & Privacy (OCP) seeks a Compliance and Audit Partner to support systemwide compliance, audit, and education initiatives. 

The position will be responsible for reporting, trends analysis, as well as policy and procedure development and management. This individual would be responsible for ensuring that EHC adheres to relevant laws, regulations, and industry standards, focusing on compliance risk areas and billing practices, while also providing ongoing educational support, and fostering a culture of compliance within the provider network.KEY RESPONSIBILITIES:1.MANAGEMENT & COMMUNICATION:

• Support the OCP by ensuring adherence to laws, regulations, and industry standards.
• This includes staying informed of changes in healthcare regulations and industry standards and updating pertinent guidance and training accordingly.
• Participate in EHC OCP compliance risk assessment process.
• Investigate compliance matters reported via the Emory Trust Line and to the EHC OCP. 
• Work to ensure timely resolution of compliance issues and facilitate communication of compliance related matters.
• Development governance-level reporting and metrics for the EHC OCP, including but not limited to dashboards, board reporting, weekly, monthly, and annual compliance & ethics reporting.
• Work with compliance leadership as well as other key clinical and operational leaders on compliance matters.
• Formulate, review, and revise compliance policies and SOPs, as directed.
• Ensure that policies and procedures are effectively communicated and enforced throughout the organization.

2. EDUCATION & TRAINING PROGRAM:

• Support the Audit and Analysis program through the development and delivery of compliance training material for providers and other stakeholders to ensure accurate and compliant reporting of industry standard billing, coding and documentation standards (ICD10, CPT, E/M, HCPCS, CDI, HCC, etc.).
• Participate in provider orientation to ensure coding and documentation expectations are clearly communicated.
• Collaborates with compliance auditors and revenue cycle teams to identify trends and address deficiencies to ensure compliance within the organization.
• Monitor regulatory changes and update guidance and educational materials accordingly.
• Track and report on education effectiveness and compliance risks.

3. AUDITING & REPORTING:

• Oversee assigned compliance and audit program including specialty and high-risk internal audits and reviews to assess compliance with policies and procedures.
• Perform audit assessments and provide oversight of compliance auditors and analysts as assigned.
• Provide monitoring, tracking and trending related to audit outcomes and communicating the results to the appropriate stakeholders. 
• Ensure that any corrective actions are implemented and tracked to completion.
• Investigate potential compliance violations and report findings to appropriate authorities.
• Collaborate with other departments and stakeholders to promote compliance throughout the organization.
• Serve as a point of contact for compliance-related questions and concerns.

MINIMUM QUALIFICATIONS:

• Bachelor's degree required.
• Masters (MA or MS) or Juris Doctorate (JD) degree preferred.
• Minimum of five years of experience in a healthcare organization.
• Healthcare compliance role is preferred.
• A minimum of five years of experience working as a medical coder, coding, auditor, and/or coding educator.
• Certified in Healthcare Compliance (CHC or CPCO) preferred.
• If no certification, must obtain one within 12 months of hire.
• AHIMA or AAPC certification required (e.g., CPC, CCS-P, CCS, CPMA, COC)
• Strong knowledge of teaching physician rules, E/M leveling, and/or split/shared services.
• Experience working in multispecialty practices, hospital-based clinics, or academic medical centers preferred.
• Strong knowledge of HIPAA, Stark-Law, and other healthcare privacy regulations.

Knowledge, Skills, and Abilities requirements:

• Ability to work on a team and work independently, when needed.
• Ability to adjust to changing work demands and multi-task.
• Thorough attention to detail and strong, problem-solving skills. 
• Strong understanding of healthcare regulations, laws, and industry standards. 
• Strong understanding of CMS and correct coding and billing requirements
• Excellent communication, interpersonal, and problem-solving skills.

Work Environment: Hybrid: 2-3 days/week onsite - Some local travel may be required for audits, training, or regulatory meetings.

Additional Details

Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.

Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare’s Human Resources at careers@emoryhealthcare.org. Please note that one week's advance notice is preferred.