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    Clinical Compliance Audit Manager - Nashville, United States - HCA

    HCA
    HCA Nashville, United States

    3 weeks ago

    HCA background
    Description
    Introduction


    Do you want to join an organization that invests in you as an Clinical Compliance Audit Manager? At HCA, you come first.

    HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years.

    Benefits

    At HCA, we want to ensure your needs are met.

    We offer eligible colleagues an attractive benefit package that includes medical, wellbeing, dental and vision benefits along with some unique benefits including:


    • Medical, Dental, Vision, Life Insurance and Flexible Spending
    • Paid Time Off (PTO) and Personal Leave
    • 401K (100% annual match - 3% to 9% of pay based on years of service)
    • Academic Assistance and Reimbursements for Tuition and Student Loans
    • Employee Discounts including Tickets, Retail, Mental Health Apps, Education Apps, Identity Theft Protection etc.
    • Home, Auto, and Pet Insurance
    • Employee Stock Purchase Program (ESPP)
    • Short Term & Long Term Disability coverage
    • Adoption Assistance
    • Legal Benefits and lots more
    Learn more about Employee Benefits

    You contribute to our success. Every role has an impact on our patients' lives and you have the opportunity to make a difference. We are looking for a dedicated Clinical Compliance Audit Manager like you to be a part of our team.

    Job Summary and Qualifications


    The Internal Audit Department provides an independent appraisal function to validate management control systems and to support corporate management in the effective discharge of their responsibilities and efforts to achieve the Company's overall mission.

    The Clinical Compliance Team work includes a variety of audits which tests the medical records and corresponding bills to ensure compliance with company policies and government regulations.

    The purpose of the audits is to assist facility management in determining compliance with company-defined processes and CMS requirements.

    The team works closely with facility, division, and group management as well as corporate responsible personnel to help effect overall compliance.

    The Clinical Compliance Audit Manager position will work on various audit engagements with team members at various levels and receive formal evaluations twice a year

    What you will do in this role:

    • Conducts reviews of hospital/center systems to ensure compliance with applicable legal, regulatory and licensure requirements as defined by CMS, state regulations and company policy.
    • Develops detailed reports specifying compliance issues identified during the audit.
    • Assists the facility with action plan development, follow-up questions. Completes process follow-up as necessary.
    • Demonstrates a thorough understanding of CMS, Joint Commission, and State Health Department regulations, regarding post-acute services, admission status, licensure/certification, clinical trials, core measures, National Coverage Determination requirements, and other review areas.
    • Discusses complex auditing issues with engagement team and client management.
    • Participates in the audit quality assurance program.
    • Communicates the objectives of each review and planned other services to the client engagement team and establishes/communicates team members' roles in the process.
    • Understands HCA Healthcare's business and the healthcare industry from a global perspective by recognizing business trends and emerging technical and industry developments of relevance and communicates these to the client engagement team and applicable management personnel.
    • Provides input and guidance in the development of, as well as the review of the detailed audit/review programs particularly focusing on complex audit issues.
    • Executes audit procedures, analyzes evidence, reaches conclusions, identifies issues, develops strategies, and makes decisions for complex, judgmental issues related to the review procedures executed. Consults with others in the Company, as necessary, on complex issues.
    • Reviews working papers and memoranda for consistency with applicable authoritative guidance and the requirements of the department.
    • Assists with educational and administrative matters (e.g. professional development programs, process improvement team initiatives, recruiting efforts, and special projects as requested by the Director).

    Specific Testwork Performed:

    • Core Measures and Healthcare Associated Infections such as Sepsis, Stroke, Central Line Associated Blood Stream Infections, Catheter Associated Urinary Tract Infections, and others.
    • Procedures such as Carotid Stents, Implantable Cardiac Defibrillators, Pacemakers, Left Atrial Appendage (LAA) Closure, Transcatheter Aortic Valve Replacement (TAVR), Bariatric Surgery, and other National Coverage Determinations,
    • Provider Licensure and Certification.
    • Inpatient Rehabilitation, Inpatient Psychiatric Services and others.
    • Telehealth (Neuro Stroke)
    • United Kingdom Quality Measures
    • Others as deemed necessary.

    What qualifications you will need:

    • Active RN Licensure with 5 or more years' experience.
    • College Graduate (from accredited School of Nursing).
    • Bachelor of Science in Nursing (BSN) preferred.
    • Nursing management/supervisory experience preferred.
    • Quality, Risk, Case Management, Utilization Management, hospital, rehab, skilled, consulting experience is preferred.
    • Ability to travel up to 20%.
    • Proficient with Excel spreadsheet and Word processing software.
    • Excellent verbal and written communication skills
    • Superior client service and business development skills, dedication to teamwork.
    • Ability to multitask and work well with deadlines/related time pressures.


    HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times.

    In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

    "Good people beget good people."- Dr. Thomas Frist, Sr.

    HCA Healthcare Co-Founder

    We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status
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