Director Compliance Audits and Revenue Cycle - Irving

Summary:

The Director Compliance Audits and Revenue Cycle contributes to CHRISTUS’s mission and vision by directing the organization’s compliance audit program and providing support and oversight for Revenue Cycle compliance. The Director will lead the overall compliance auditing activities to ensure compliance with standard operating procedures, organization policies, industry standards, and applicable federal and state laws and ensure systematic adherence to legal and regulatory requirements throughout the revenue cycle.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Leads the development and execution of the annual Compliance Work Plan.
• Responsible for the management of the CHRISTUS Revenue Cycle compliance program.
• Serves as the primary liaison with CHRISTUS Health’s Revenue Cycle Department in coordinating the response to audits and investigations conducted by regulatory agencies and contractors related to billing, coding, clinical documentation, medical necessity, appropriateness of care, and other issues involving Medicare, Medicaid, and other federal and state health care programs.
• Designs and implements innovative approaches for using technology to support continuous auditing and monitoring of CHRISTUS Health’s operations in support of the Compliance Program through data mining, analytics, and benchmarking.
• Manages the compliance work plans, internal and external audits, and reviews and provides assurance that the organization is operating efficiently and effectively.
• Provides subject-matter expertise, sound judgment, and a strategic understanding of risk-based audit approach.
• Maintains strong relationships with the Patient Access, Coding, Billing, and Reimbursement teams to ensure that documentation issues, patterns, and/or trends are identified, prevented, and addressed through education and effective corrective action in a timely manner.
• Serves as a resource for the organization to ensure compliance with applicable state and federal regulations relating to documentation, coding, reporting, and billing of health care services.
• Identifies revenue cycle-related risk areas, conducts audits of such risk areas, and recommends measures to reduce risk and promote compliance with applicable rules.
• Remains current with new rules, regulations, and revisions set forth by CMS and other entities regarding Revenue Cycle Compliance.
• Maintains revenue cycle oversight by staying updated on state laws, guidelines, and payer policies to avoid penalties, fines, and reputational harm due to non-compliance.
• Monitors regulatory, legal, and industry developments and identifies opportunities for their application to the Corporate Compliance program.

Requirements:

• Bachelor’s Degree in Hospital Administration, Finance, Law, Accounting, Health Services Management, Health Information Management, Nursing or Business required. 
• Master’s Degree in Hospital Administration, Finance, Law, Accounting, Health Services Management, Health Information Management, Nursing or Business or Juris Doctor preferred. 
• Ability to be flexible, multitask, switch priorities, and work comfortably in a deadline-driven/productive environment. 
• 10+ years of leadership experience in healthcare compliance, legal, audit, administration, or operations is required. 
• Minimum of 5 years of experience leading system/regional-level compliance audit programs. 
• Certification in Healthcare Compliance (CHC) is preferred. 
• Certified Healthcare Auditor (CHA) or similar is preferred.

Work Schedule:

5 Days - 8 Hours

Work Type:

Full Time

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