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ECU Health is a mission-driven, 1,708-bed academic healthcare system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals, and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations.
The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children’s Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education, and research.
Position Summary
Perform compliance audits and monitoring activities across ECU Health to ensure data integrity and compliance with federal and state regulations pertaining to, but not limited to: complete revenue cycle, medical record documentation, coding and billing, conflict of interest, and clinical trials billing. Coordinates external governmental agency medical or financial record requests. Responds to and investigate allegations of non-compliance and ensure allegations, concerns or questions relating to other ECU Health departments are routed appropriately. Provides guidance, conducts research, and acts as a subject matter expert regarding compliance matters. Serves as a resource for general healthcare compliance practices.
Responsibilities
1. Supports the Office of Audit and Compliance leadership in developing, implementing, and maintaining the VH annual Risk Assessment and associated Work Plan. Ensures successful completion of assigned audit/monitoring projects and programs as designated in the VH Compliance Plan.
a. Conducts assigned projects successfully from beginning to end within designated timeframes. Identifies and communicates issues and concerns raised, offering recommended solutions to improve processes and promote compliance. Audits and/or monitoring activities may include, but are not limited to medical documentation, coding, billing, and general compliance.
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b. Develop and track compliance corrective action plans that result from audits.
2. Autonomously or with minimal oversight, conducts audit/monitoring activities as delegated by the Director of Compliance & Privacy and/or the Chief Audit and Compliance Officer. Communicates identified findings and recommendations with Compliance management to ensure any potential concerns are addressed in a timely and effective manner. May act as subject matter expert to ensure recommendations are implemented.
3. Prepares clear and concise project communications, documents, and reports.
a. Keeps the business or clinical area leader informed of significant findings detected during all compliance projects.
b. Fully documents activities in departmental databases.
c. Investigate, conduct research, and respond to compliance questions and concerns, a timely and with supporting guidance; if necessary.
d. Monitors federal, state, and local Medicare contractor regulations for compliance-related changes that may impact the organization.
4. Responsibilities may include general oversight of Recovery Audit Contractor (RAC), Medicare Administrative (MAC), Medicaid Integrity Program (MIP) Supplemental Medicare, Zone Program Integrity (ZPIC) Comprehensive Error Rate Testing (CERT), and other governmental contractor activities:
a. Supporting processes that ensure RAC/MAC/ MIP and other governmental requests are received, communicated to appropriate entity staff, and documented in EPIC Program Integrity Module (PIM)
b. Training users of EPIC PIM and troubleshooting issues identified with the EPIC PIM
c. Prepare reports from EPIC PIM for Director or CACO, Operations or clinical management in order to improve performance
d. Serve as a technical resource for EPIC PIM users when concerns arise regarding proper data entry
5. Performs compliance awareness and training as needs are identified or requested.
6. Maintains open communications with VH leadership/management.
a. Works well with other health system team members (i.e., internal audit team, health information management, revenue cycle/financial services, clinical staff).
7. Maintains a high level of competency related to compliance by attending appropriate webinars/conferences and participating in relevant organizational committees and/or work groups as delegated.
a. Ensures adequate focus on personal professional growth relevant to taking on more challenging assignments; proactively seeks relevant education and training opportunities.
b. Maintains compliance with all health system policies and procedures.
8. Willing to travel for compliance audits/projects and education.
9. Assists the Director of Compliance & Privacy and/or the Chief Audit and Compliance Officer with other duties as assigned.
Minimum Requirements
Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Specialist (CCSP), or Certified Professional Coder (CPC) certifications are required.
A minimum of three (3) years of experience in healthcare facilities, outside regulatory agencies, compliance, or healthcare auditors is required.
Certified in Healthcare Compliance (CHC) is required or must be obtained within the first year of employment.
Other relevant degrees, certifications, and/or experience may be considered as equivalent as described herein.
Strong organizational and oral and written communication skills, analytical and reporting skills, and proficiency with MS Office products as Excel, PowerPoint, SharePoint, and EMR systems (e.g., EPIC). Experience with paper, computerized, and hybrid medical records.
General Statement
It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.
Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.
We value diversity and are proud to be an equal-opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.
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