Field Director, ComplianceLouisville, Kentucky
We are recruiting for a Field Director Compliance to join our Compliance Team. This is a remote position.
Contributes to fulfillment of the organization's mission to conduct all aspects of its business in an ethical and legal manner. Provides evaluation, education and consultation utilizing, CMS Regulations, licensing requirements, Kindred policies and procedures. Monitors, evaluates and investigates potential risk exposure of facilities by monitoring the MDS/PPS process, billing, reimbursement, compliance of reimbursement for the assigned divisions, quality of care, quality assurance, quality improvement processes and the elements of Kindred Compliance Program. Assesses and reports compliance with applicable requirements, and provides consultation and training to staff with the goal of improving quality of care, accurate billing, and reducing future risk exposures to the organization. Participates in other activities as assigned.
- Conduct on and off site data reviews and audits to evaluate compliance with quality care, MDS/PPS, billing, documentation, utilization and reimbursement requirements, and to identify potential risk areas as well as best practices. Conduct on and off-site audits, records review, and observation of systems and processes to identify potential risk areas and best practices, and to provide consultation and training. Facilitate early and appropriate interventions to potential risks as well as promote best practices. As indicated or requested, conduct follow-up reviews/visits and/or ensure corrective action is implemented.
- Provide expertise and serve as a resource on implementation, education and compliance with the Kindred Ethics and Compliance Program.
- Collaborate with the Kindred Compliance Program in establishing standards, processes, and assessment tools to evaluate quality of care, documentation, utilization of services, billing and reimbursement issues to the facility, district, regional and support center levels.
- Collaborate with the Kindred Compliance Program staff in establishing tracking mechanisms of evaluation/assessment results to identify trends and respond to non-compliance related to quality of care, documentation, utilization of services, billing and reimbursement issues to the facility, district, regional and support center levels.
- Assist the Divisions in responding effectively to identify compliance issues related to quality of care, documentation, MDS/PPS, utilization, billing and reimbursement in a manner that supports operational strategies.
- Assist the Divisions with understanding and disseminating changes in healthcare regulations or standards and in the application of such changes to current policies, procedures or processes.
- Assist with implementation and or refinement of compliance strategies.
- Assist in the development of compliance general and role based training.
- Provide formal and informal training on compliance, billing, and MDS/PPS, performance improvement topics and other topics that are part of the overall Kindred Compliance Program.
- Perform investigations of MDS/PPS, billing, and utilization related compliance issues that are reported to the compliance department or through the legal department. These investigations may include document review, interviews, on site visits or other investigative means. Document the results the results of reviews, audits or investigations including any recommended corrective action. Monitor implementation of corrective action plans and document resolution of identified issues.
- Identify and report findings, trends, problems, and activities that may indicate a need for a change in policies, procedures, internal controls, or training. Conduct on-site training related to Kindred Compliance Program, including, but not limited to, Compliance Tracker, Fraud/Waste/Abuse, HIPAA.
- Knowledge of quality, billing and reimbursement related healthcare regulations, clinical systems, and healthcare operations. Experienced in conducting investigations, identifying trends, assessment, care planning, quality assurance, and quality improvement systems.
- Strong analytical and problem-solving skills.
- Basic computer skills, and the ability to develop spreadsheets and reports.
- Effective communication skills.
- Ability to work cooperatively in a team environment.
- Approximate percent of time required to travel: 75
- Associate degree in related field required. Bachelor's degree preferred.
- Clinical, Compliance or Audit license/certification current.
- 5 years of clinical, billing or audit experience in a healthcare setting, including assessment, care planning, quality assurance, and quality improvement systems. Must have experience with utilization, billing and reimbursement processes. Degree or certification with appropriate experience in quality systems is beneficial.
- 3 years experience with clinical services such as LTACHs, Therapy, SNF, Hospice and Behavioral Health.
- Extensive expierience with ICD-10 coding, preferable in the LTAC or IRF specialty.
Depending on candidate’s qualifications, this position may be filled at a different level.
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