Job description

Nuvance Health has a network of convenient hospital and outpatient locations — Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York — plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology care, and two urgent care offices. Non-acute care is offered through various affiliates, including the Thompson House for rehabilitation and skilled nursing services, and the Home Care organizations.

Summary:

Reporting to the Special Associate Compliance Officer (SACO) Physician Audit & Billing, the Senior Inpatient Professional Auditor provides Hospital Inpatient and Outpatient coding, billing, and documentation auditing and education to the NUVANCE HEALTH network. Effectively interacts with, all departments and different levels of management across the Nuvance Health network.

Responsibilities:

1.Under the leadership of the SACO, coordinate high volume of coding compliance audits across all Nuvance Hospitals in accordance with the Department Work Plan and other audits identified by Compliance Management; Reviews documentation and coding to ensure compliance with all Federal and State guidelines. Ensure correct DRG and APC assignments for Institutional claims.

2.Maintain confidentiality of protected health information and other forms of confidential information as required under (i) applicable Federal and State law including, without limitation, HIPAA and New York and Connecticut patient and personal/private information confidentiality laws, respectively; and (ii) Nuvance Health policies and procedures.

3.Provide comprehensive guidance regarding proper coding and documentation practices consistent with Nuvance Health policies and best practices, and all coding, Federal and State regulatory and reimbursement guidelines, maintaining compliance;

4. Assist with development, updating, maintenance, and disseminating training and education materials to Nuvance Health clinicians, managers, and coding department staff. Provide material and conduct presentations for Compliance education programs as needed.

5. Communicate and reinforce proper documentation, coding and billing rules and regulations consistent with Nuvance Health policies, i.e., Center for Medicare & Medicaid Services (CMS), American Medical Association (AMA), American Health Information Management Association (AHIMA), to ensure appropriate Current Procedural Terminology (CPT), ICD-9-Clinical Modification (CM), ICD-10-Clinical Modification (CM), Healthcare Common procedure Coding System (HCPCS) and ICD-10-Procedural Classification System (PCS) coding for the Network's Hospital Inpatient and Outpatient coders and services.

6.Assist SACO and/or SCO with coordination and management of all government audits for Hospital services including, Medicare, Medicaid, Recovery Audit Contractor (RAC), Target Probe & Educate (TPE), Comprehensive Error Rate Testing (CERT) etc., and third party payer commercial audits for the Network's Hospital patient services. Review audit results and recommendations for improvement or compliance with SACO.

7. Perform independent research, assessment and remain current with CMS, NGS Medicare, and Office of Inspector General (OIG) regulations, guidelines, bulletins, coding practices & methods, annual, semi-annual, and quarterly coding updates and other publications for impact on Institutional services. Monitor daily notifications and listservs such as CMS, Medicare, NGS, AHIMA, etc., and third-party payers for updates and changes in regulations and professional and peer organizations’ practices/policies/guidelines to keep Nuvance Health current with regulatory requirements and accepted compliance and audit practices.

8. Collaborate with the Hospital Coding Department coders to identify errors, patterns, trends, and variances in documentation and coding practices. Document findings utilizing industry compliance standards, and report patterns or concerns to SACO or SCO. Provide recommendations and feedback to SACO or SCO to improve and optimize compliant coding, billing, or documentation practices. Respond to all inquiries in a professional and timely manner.

9. Record and track all DRG and APC compliance audits, assessments, and corrective action plans for Nuvance Health in the compliance tracking logs or vendor-provided databases in accordance with department procedures and audit activity processes. Document and capture timely updates until all corrective action plans are implemented and completed. Perform timely follow-up on outstanding compliance issues; ensure any required changes have occurred to coding, billing, documentation practices, and any associated policies or procedures.

10.Assist SACO and or SCO during compliance investigations pertaining to Hospital coding and documentation as required. Support the Senior Compliance Officer (SCO)Quality, Clinical and Physician Audit, and Billing Cycle Integrity as requested.

11.Utilize Quarterly PEPPER reports for data mining to identify items for auditing and monitoring efforts to help Nuvance Health identify and prevent payment errors. Communicate the information with Nuvance Health stakeholders in developing Corrective Action Plans where needed.

12.Performs other duties as assigned and in support of the SACO, SCO, and the Nuvance Health Compliance Program.

Requirements:

• RHIT or CCS (Additional certifications or licenses are a plus)
• Associate Degree required or five + years job-related experience in a Compliance Auditing position
• Bachelor’s Degree preferred
• Hospital Inpatient and Outpatient coding experience
• Desired: Knowledge of Nuvance Health network documentation and billing systems
• Knowledge in relation to anatomy physiology, medical terminology, and the disease process
• Proficient skills with Word, Excel, PowerPoint, and Coding software
• Proficient presentation or education experience
• Extensive coding experience
• Hospital claim audit experience and knowledge
• Excellent and strong verbal and written communication skills

Other information:

Location: Summit-100 Reserve Rd

Work Type: Full-Time

Standard Hours: 40.00

FTE: 1.000000

Work Schedule: Day 8

Work Shift: Monday through Friday from 8am to 4:30pm

Org Unit: 1771

Department: Corporate Compliance

Exempt: Yes

Grade: S9

Salary Range:

$27.9100 - $51.8300 Hourly

Education:
Essential:
* Associate's Level Degree

Working conditions:
Essential:
* Some manual skills / motor coord & finger dexterity
* Little or no potential for occupational risk
* Sedentary/light effort. May exert up to 10 lbs. force
* Generally pleasant working conditions.

EOE, including disability/vets.

We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business. If you believe you require such assistance to complete this form or to participate in an interview, please contact Human Resources at 203-739-7330 (for reasonable accommodation requests only). Please provide all information requested to assure that you are considered for current or future opportunities.

NHTA1

Job Type: Full-time

Pay: $27.91 - $51.83 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Work Location: Hybrid remote in Danbury, CT 06810

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