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LHC Group - RN Careers

Clinical Compliance Auditor - RN Job

Job Number: 2017-15630

Agency: LHC Group Inc Home Office

Location: Lafayette, LA

Schedule: Full-Time

Full Job Title: Clinical Compliance Auditor, RN - Louisiana

Overview:

LHC Group is the preferred post-acute care partner for hospitals, physicians and families nationwide. From home health and hospice care to long-term acute care and community-based services, we deliver high-quality, cost-effective care that empowers patients to manage their health at home. More than 60 leading hospitals and health systems around the country have partnered with LHC Group to deliver patient-centered care in the home. More hospitals, physicians and families choose LHC Group, because our 11,000 employees in 25 states are united by a single, shared purpose: It's all about helping people.

The Clinical Compliance Auditor will report to the Clinical Compliance Audit Manager and will assist the Director with compliance auditing and monitoring activities within the homecare, hospice and LTAC agencies at LHC Group, Inc. (LHC) to ensure business areas have processes or policies in place to comply with applicable State and Federal laws and regulations related to Medicare and Medicaid rules and regulations, as described by the annual compliance work plan developed by the Chief Compliance Officer (CCO). The clinical and business areas will include, but are not limited to: eligibility, billing, coding, clinical documentation and referrals. Independent monitoring includes analyzing risk assessments, performing audits (including detailed audits of patient medical records), creating reports, educating and following up with agencies to ensure processes exist that demonstrate compliance with applicable State and Federal laws, regulations, policies and procedures. The Clinical Compliance Auditor will coordinate internal audits, analyses, reviews and investigations of home health, hospice and LTAC locations within LHC as assigned by the CCO or the manager and provide recommendations to improve compliance and internal controls with applicable State and Federal laws and regulations related to Medicare and Medicaid.

Additional Details:

Essential Functions

Performs audits (including detailed audits of patient medical records) of home health, hospice and LTAC locations as assigned by the CCO or the manager, identifying and researching issues and making recommendations to improve, so the home health, hospice and LTAC locations are in compliance with all legal requirements, policies and procedures and with any other risk areas identified by the CCO (collectively, the Compliance Risk Areas).

Performs preaudit preparation including, but not limited to, sample selection|stratification, agency notification of audit and record preparation.

Communicates and educates the home health, hospice and LTAC locations as assigned on the audit findings an recommendations, ensuring recommendations are implemented by working cooperatively with the appropriate personnel.


Conducts Corporate Compliance Program education and training related to policies and procedures, regulations, or legislation that impact operations, as needed or assigned.


Creates reports based on audit results of the home health locations audited.


Coordinates follow-up and resolution to investigations and audit findings as needed.


Orients new Clinical Compliance Auditors as directed by the CCO or the Director.

Assists the CCO or the Compliance Director with any other audit items as assigned.

Works from home office, Lafayette, LA, (preferred) or on site at assigned agency as directed by the CCO or the Director.

Performs travel as needed to home health locations and LHC's home office in Lafayette, LA as assigned or requested by the CCO or the manager.

Makes random agency compliance check visits on site as assigned.

Assists Clinical Compliacne Director in planning|organizing audit plans and post audit assessments.

Provides on-going advice and resources to management in the area of process improvement to support Corporate Compliance Program effectiveness.

Maintains a working knowledge of Federal and State laws, regulations and policies applicable to LHC.

Stays abreast of external developments in compliance, including government investigations and industry best practices.

Performs|participates in Post Audit action plan oversight and instructs agencies appropriately in accordance with LHC policies and procedures.

Participates in conference calls, webexs', and on-site meetings/training as assigned or requested.

Conducts compliance related investigations and follows up with Clinical Compliance Director or CCO for resolutions.

Performs other duties as assigned by the CCO or the Director as needed.

Qualifications:

Experience: 5 years
Education Requirements
  • Registered Nurse degree
Experience Requirements
  • Significant exposure to Medicare/Medicaid reimbursement and regulations, internal auditing, healthcare, operations, patient care plans and medical records, Stark law, anti-kickback laws and fraud and abuse laws.
Experience Desired
  • Significant audit experience
  • Certified Professional Coder (CPC), Certified Coding Specialist (CCS) and/or Certified Homecare Coding Specialist (HCS-D) is preferred, along with home health coding experience.
Skill Desired
  • Certified OASIS Specialist (COS-C)
  • Certified Coder (HCS-D)

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