<p>Welcome! We're excited you're considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you'll find other important information about this position.</p> <p>This role will assist leadership to ensure that WVUHS and its entities remain in compliance with all federal healthcare program rules, regulations, administrative requirements, and guidance. This position will be responsible for the monitoring of policies and procedures to assure continued compliance; responsible for planning, developing and conducting training sessions to educate staff on compliance-related issues; conducting compliance audits and reviews; and conducting presentations related to compliance-related topics. This position may attend meetings as assigned to represent the Compliance Department. The overall purpose of this position is to promote active organizational compliance, promote awareness of compliance and understanding of positive ethical values consistent with the mission and values of WVU Medicine and assisting in the achievement of organization wide objectives.</p> <p>MINIMUM QUALIFICATIONS:</p> <p>EDUCATION, CERTIFICATION, AND/OR LICENSURE:</p> <ol> <li>Associate's degree in healthcare administration, business administration, or related field AND Four (4) years of experience in a healthcare organization including compliance, coding, and/or billing/revenue cycle knowledge; OR High School Diploma or equivalent AND Six (6) years of experience in healthcare management. </li></ol> <p>PREFERRED QUALIFICATIONS:</p> <p>EDUCATION, CERTIFICATION, AND/OR LICENSURE:</p> <ol> <li>Certification in one of the following: CPC (Certified Professional Coder), COC (Certified Outpatient Coder), CPC-H (Certified Professional Coder-Hospital Outpatient), CCS-P (Certified Coding Specialist-Physician-Based), RHIA (Registered Health Information Administrator), or RHIT (Registered Health Information Technician). </li></ol> <p>CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.</p> <ol> <li> <p>Develops, maintains and supports the implementation and ongoing efforts of the Compliance Program.</p> </li><li> <p>Participates in the annual and ongoing assessment of regulatory and administrative risk and contributes to the development of the annual compliance work plan targeting the areas for review and other investigation. Works with leadership in development of new activities and analysis such as trending and risk assessment. Responds to internal requests for auditing and monitoring issues/concerns.</p> </li><li> <p>Collects data and responds to issues and concerns raised via the Hotline or internal questions and concerns raised by employees and management as directed by leadership.</p> </li><li> <p>Prepares and submits to leadership summaries of completed audits to be included in documents provided to specified boards and board committees. The summaries include the subject, background, findings, recommendations, and any corrective actions. Maintains a database of audit findings for tracking, trending and detecting of any compliance risks.</p> </li><li> <p>Serves as compliance representative on assigned teams or committees to provide input and ensure that reporting systems, procedures, and processes are altered or maintained to ensure compliance with applicable laws, regulations, and policies.</p> </li><li> <p>Conducts compliance-related audits and reviews to ensure regulatory and administrative requirements are met. Coordinates with departments to conduct compliance audits and reviews as necessary. Formulates and defines scope and objectives of audit or review. Researches regulatory requirements that pertain to the audit or review. Reviews medical record, billing, or other relevant documentation. Writes formal audit reports. Responsible for review and correction of reports prior to submission to departments and/or management. As directed by leadership, leads and conducts meetings with respective departments to review audit reports and develop corrective action plans if necessary.</p> </li><li> <p>Plans, develops and conducts presentations for internal and external departments. Plans informational programs and training sessions to educate hospital staff, both departmentally and institution-wide, on current and changing compliance and regulatory requirements.</p> </li><li> <p>Promotes awareness and understanding of new and existing compliance issues and policies and procedures via constant reinforcement of the organizations' Code of Conduct/Ethics, the Compliance Hotline process, and other mechanisms designed to raise awareness of issues in the workplace.</p> </li><li> <p>Reviews new or revised regulations or policies issued by regulatory agencies to determine how they apply at their assigned facility (facilities). Advises staff on new or revised regulatory requirements, and the development and implementation of compliant processes to address potential high-risk practices. Conducts ongoing auditing, monitoring and/or investigations related to compliance with policy and regulatory requirements as assigned by leadership.</p> </li><li> <p>May assist leadership with federal payor audit requests (i.e., CERT, PERM, MIC, etc.) and with any external audit activities</p> </li><li> <p>May serve as a subject matter expert on standards for coding, medical record documentation, billing and reimbursement rules to advise providers and organization for professional and hospital-based services.</p> </li><li> <p>Maintains and enhances current knowledge of compliance through attendance of meetings and seminars, study of reference materials, and updates to compliance rules and regulations. Reviews newsletters, journals, best practices, updates to compliance rules and regulations, etc.</p> </li></ol> <p>PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</p> <p>WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</p> <p>SKILLS AND ABILITIES:</p> <ol> <li> <p>Excellent organizational and time management skills.</p> </li><li> <p>Outstanding verbal and written communication skills.</p> </li><li> <p>Excellent presentation skills preferred.</p> </li><li> <p>Ability to utilize electronic medical record and billing systems.</p> </li><li> <p>Extensive knowledge of healthcare compliance, revenue cycle operations, and auditing techniques.</p> </li><li> <p>Advanced compliance, coding, and billing/revenue cycle knowledge.</p> </li></ol> <p>Additional Job Description:</p> <p>Scheduled Weekly Hours:</p> <p>40</p> <p>Shift:</p> <p>Day (United States of America)</p> <p>Exempt/Non-Exempt:</p> <p>United States of America (Exempt)</p> <p>Company:</p> <p>SYSTEM West Virginia University Health System</p> <p>Cost Center:</p> <p>508 SYSTEM Compliance</p> <p>Address:</p> <p>327 Washington Ave</p> <p>Wheeling</p> <p>West Virginia</p> <p>Equal Opportunity Employer</p> <p>West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.</p>