Medicaid Auditor Jobs (NOW HIRING)

Corporate Compliance

LMHS Compliance Auditor

Licking Memorial Health Systems (LMHS) is a leading, non-profit healthcare organization, passionately dedicated to improving the health and well-being of our community. With a history dating back to 1898, LMHS remains a cornerstone of healthcare excellence, catering to the evolving needs of Licking County. Our cutting-edge facility provides a comprehensive spectrum of patient care services, from life-saving emergency medicine to the comforting embrace of home healthcare, with a unique range of specialized medical services, including cancer, heart health, maternity, and mental wellness.

When you join the LMHS team, you become a vital part of your local community Hospital. Working at LMHS is not just a job, it is a unique opportunity to directly impact the health and well-being of your friends, family, and neighbors. You will be providing care in a place in which you are personally connected, where the impact of your work extends beyond the Hospital doors and into the heart of our community. Our commitment to diversity, equity, and inclusion ensures that every member of our community is served with respect and compassion. Join us in our mission – dedicated to patient safety, utilizing state-of-the-art technology, and with a passionate team of highly trained and compassionate individuals who strive to improve the health of the community.

Position Description

Under the general direction of the VP of Financial Services, this position provides overall compliance auditing and monitoring of the Health Systems. This position safeguards the Health Systems compliance with state and federal documentation and billing requirements.

Responsibilities

• Primary focus on the compliance of home care, patient level of care, and patient status but also responsible for internal auditing of processes and practices to help assure consistency with federal and state law to include but not limited to compliance with the: Centers for Medicare and Medicaid Services (CMS), Office of Inspector General (OIG), Ohio Department of Health (ODH), Ohio Department of Medicaid (ODM), and Recovery Audit Contractors (RAC).
• Communicate with external agencies regarding audits.
• Responsible for auditing charge capture processes, coding and billing processes, and assisting in resolution of case or system failures.
• Provide consultation in the application of process improvement principles as they relate to the results of any compliance audit functions and findings.
• Knowledgeable in Medicare and Medicaid regulations and billing practices to appropriately guide and advise staff and processes.
• Offer expertise to departmental personnel and medical staff in the areas of coding, billing, and compliance.
• Effectively work with multi-disciplinary groups, skilled with interacting with physicians, nurses, and other healthcare professionals.
• Research regulations/rules/laws to effectively analyze concerns and develop well-reasoned solutions based on official resources, recognize and validate assumptions, collect information, and draw meaningful inferences.
• Maintain confidentiality and a sense of credibility and reliability.

Requirements

• Licensed Practical Nurse (LPN), Registered Nurse (RN), or bachelor’s prepared individual with significant healthcare and auditing experience. Clinical background is strongly preferred.
• A minimum of three to five years in a healthcare setting.
• Knowledge of Medicare/Medicaid laws.
• Superior interpersonal, analytical and computer skills, as well as the ability to work independently.
• Must have the appropriate background and knowledge needed to assess clinical documentation and medical record coding and to analyze data and identify trends and outliers.
• Excellent written and verbal communication skills that will support professional communication with all levels of management.
• Healthcare auditing experience preferred.
• Not a remote position.
• LMH is accredited by DNV and TJC, and as such, may require specific annual education related to specialty certifications and standards.

Licking Memorial Health Systems is an equal opportunity employer and maintains compliance with all state, federal, and local regulations. Licking Memorial Health Systems does not discriminate against applicants because of race, religion, color, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit based factors protected by law.