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Primary City/State:
Phoenix, ArizonaDepartment Name:
Compliance-CorpWork Shift:
DayJob Category:
ComplianceA rewarding career that fits your life. As an employer of the future, we are proud to offer our team members many career and lifestyle choices including remote work options. If you’re looking to leverage your abilities – you belong at Banner Health!
Innovation, a love of finding the answer, and growth. Joining the Banner Health Compliance team, as a Senior Compliance Audit Consultant for Banner Health’s Insurance Division, offers you all three of these opportunities! Innovation as the audit team reviews growing lines of business, so the work stays challenging. You will also have opportunity to grow your professional and leadership skills. You will interact with, and present to, leadership roles across Compliance and Operations departments within Banner as well. You will do all of this while working alongside a team of passionate Compliance professionals that, together, both manage the direct care for members of this organization as well as provide administrative services.
This is a day shift position Monday - Friday, 8 hour workdays, with some variation based on work demands. You will primarily work remote with occasional travel to the Banner Health Corporate Phoenix Office. Local candidates only.
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 high level complex clinical, medical necessity, coding, billing and other business procedure audits and prepares and presents reports of findings at the direction of compliance leadership. Perform at a high level of expertise demonstrating comprehensive regulatory knowledge and project management skills. Acts as a liaison to operational and clinical departments regarding compliance regulatory issues. 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. Manages highly complex and sensitive questions, concerns and complaints related to compliance matters, providing answers and support t system, divisional, regional and facility leadership. Ensures that reasonable steps are taken to respond timely and appropriately to compliance issues and concerns.
3. In consultation with others in the Compliance and Legal Departments, manages Banner’s response to governmental or other third-party audits, investigations or inquiries. Works with system-wide groups and committees to develop policies or processes to address identified issues.
4. Supports the system, division, regional or facility compliance management staff by responding to questions or concerns, researching matters of note, providing training as necessary and developing processes and procedures to remediate concerns or issues.
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. Stay knowledgeable on current compliance-related laws and regulations through personal initiative, seminars, training programs and peer contact.
6. 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.
7. 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.
8. Assists the organization's compliance leadership as directed. This may include the following: Research and investigate complaints, concerns or questions relative to compliance issues. Investigate and follow up on reported issues. Assist with mentoring, training, recruitment, and onboarding of team members. Perform review of audit deliverables. Direct daily audit team operations and assists in the creation and modification of annual audit work plans. Assume additional responsibilities to assist and support the organization's compliance program often dealing with complex and unique situations and problems.
9. 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 significant payer, clinical or healthcare operations experience and/or 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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