Compliance Auditor - RUHS MC at County of Riverside in Riverside, California

Job Description:

ABOUT THE POSITION

Riverside University Health System (RUHS) s eeks a Compliance Auditor ( Administrative Services Manager I), to support the health system's Corporate Compliance Department. The Compliance Auditor will be responsible for reviewing inpatient and/or outpatient records for quality and comprehensive coding.

The incumbent reviews records regarding coding regulations and compliance and provides feedback and education to coders and/or physicians. The Compliance Auditor is responsible for performing annual, periodic or other focused medical record audits as requested to oversee the quality and accuracy of physician, inpatient and outpatient coding and documentation. This position requires effective communication with all RAC stakeholders and excellent organizational skills to ensure timeliness and accuracy of response requests, as well as continual program development through training and process improvement. The incumbent should have experience creating and delivering coding presentations to a variety of audiences and be comfortable communicating with physicians. This position may provide supervision to department staff.

The ideal candidate for this position will possess five (5) years of experience coding inpatient and/or outpatient records in ahospital utilizing ICD-10/CPT/HCPCS and other third-party payor codes. This experience must include at least two years of lead or supervisory experience. CPMA certification is preferred.

Work Schedule: 9/80

Work Address: 7898 Mission Grove Parkway, Riverside

Meet the Team! Riverside University Health System-Medical Center consistently receives national recognition for its progressive and innovative care, as well as being known as one of the top employers in the region. The 439-bed Medical Center is a designated Stroke Center, Level I Trauma Center, and the only Pediatric ICU in the region. Can you see yourself here?

For more information on RUHS-Medical Center, please visit www.ruhealth.org
For questions regarding this recruitment contact the recruiter, Angela Levinson :
alevinson@rivco.org / 951-955-5562

EXAMPLES OF ESSENTIAL DUTIES
Establishes implements and maintains a review process for coding/CDI compliance, including a formal review (audit) process.

Reviews inpatient and/or outpatient coded records for quality and comprehensive coding and documentation to ensure compliance with ICD-10-CM, CPT4, and HCPCS level II coding conventions.

Analyzes and interprets coding data to identify problems or trends.

Ensures compliance with clinical documentation Integrity, coding standards and government regulations.

Maintains knowledge of coding and billing requirements and regulatory changes.

Assists in the ongoing development and maintenance of a coding/abstracting policies, procedure and practice standards.

Audits, reports and documents all results to the Compliance officer utilizing spreadsheet/software algorithms as necessary.

Provides, initiates, and supports training/education for the coding and compliance regulations to all RUHS staff as needed. Creates videos and educational modules on updates as required.
Supports the education and compliance for RUHS post query, re-coding and re-billing process.
Assists with organizational training and skills assessment for ICD-10-CM/PCS.

Actively communicates and provides timely feedback to all coding and nursing affiliates as necessary.

Ability work independently with minimum supervision

MINIMUM QUALIFICATIONS

Education: Graduation from an accredited college or university with a bachelor's degree, preferably with a major in accounting, business or public administration, information services, finance, or a closely related field to the assignment. (Additional qualifying experience may be substituted for the required education on the basis of one year of full-time experience equaling 30 semester or 45 quarter units of the required education.)

Experience: Three years of experience in an administrative or staff capacity which must have included at least two years of experience supervising professional and technical staff in two of the following areas: gathering and compiling facts and statistics to evaluate program effectiveness and recommend program revisions; preparing and maintaining a program budget or maintaining and controlling the fiscal record keeping functions and systems in a department, agency, division, unit or company; coordinating and conducting studies of administrative and operational activities including budget preparation and control, equipment usage, staff patterns, work flow and space utilization. (Possession of a Master's degree from an accredited college or university in accounting, business or public administration, finance, or a closely related field may substitute for up to two years of the required experience on the basis of 30 semester or 45 quarter units equaling one year of full-time experience.)

Preferred Experience:The ideal candidate for this position will possess five (5) years of experience coding inpatient and/or outpatient records in anhospital utilizing ICD-9/ICD-10/CPT/HCPCS and other third-party payor codes. This experience must include at least two (2) years of lead or supervisory experience.

Certifications (required): Must possess and maintain at least one of the following:

• Certified Coding Specialist (CCS)
  


• Certified Professional Coder (CPC)
  


• Registered Health Information Tech/Administrator (RHIT/RHIA)
  


• Certified Document Integrity Practitioner (CDIP)
  

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APPLICATION INFORMATION

Veteran's Preference
The County has a Veterans Preference Policy applicable to new hires. To qualify, upload a copy of your (or your spouse's) Member-4 Form DD-214 indicating dates of service, and a copy of your spouse's letter of disability (if applicable) with your application. For privacy reasons, it is recommended that you remove your social security information from the document(s). A Human Resources Representative will review the materials and determine if you qualify for veterans' preference.The Veterans Preference Policy, C-3 is available here: https://rivcocob.org/board-policies

Reasonable Accommodations
The County of Riverside is committed to providing reasonable accommodation to applicants as required by the Americans with Disabilities Act (ADA) and Fair Employment and Housing Act (FEHA). Qualified individuals with disabilities who need a reasonable accommodation during the application or selection process should contact the recruiter for the position noted above. For additional information and/or to obtain the appropriate form for requesting a reasonable accommodation, please visit the Disability Access Office web page located at: https://rc-hr.com/disability

Proof of Education
If using education to qualify or when requested by the recruiter, upload a copy of any license(s), official/unofficial transcript(s), degrees, and/or related employment documents to your NeoGov account at the time of application and before the closing date. Official or unofficial transcripts will be accepted.

If your education was completed outside of the United States, you will need to provide a copy of your Foreign Education Equivalency evaluation from a member of the National Association of Credential Evaluation Services ( NACES ) or Association of International Credential Evaluators, Inc. ( AICE ).

Equal Opportunity Employer
The County of Riverside is an Equal Opportunity Employer. It is the policy of the County of Riverside to provide equal employment opportunities for all qualified persons. All applicants will be considered without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender, gender identity, gender expression, marital status, ancestry, medical condition (cancer and genetic characteristics), genetic information, or denial of medical and family care leave, or any other non-job-related factors.

Pre-Employment
All employment offers are contingent upon successful completion of pre-employment requirements including a criminal background investigation, which involves fingerprinting. (A felony or misdemeanor conviction may disqualify the applicant from County employment). A pre-employment physical examination and background check may be required.

Probationary Period
As an Approved Local Merit System, all County of Riverside employees, except those serving "At Will," are subject to the probationary period provisions as specified in the applicable Memorandum of Understanding, County Resolution, or Salary Ordinance. Temporary and Per Diem employees serve at the pleasure of the agency/department head.

General Information
Current County of Riverside and/or current employees of the hiring department may receive priority consideration. Qualified candidates may be considered for future County vacancies.

Job postings may close without notice based on application volume. Submit your complete application by the recruitment close date; no late applications are accepted. Ensure all relevant experience/education is reflected on your application/resume, as a failure to demonstrate position requirements may disqualify applicants. A description of job duties directly copied from the job classification or job posting will not be considered.

Please read and follow any special application instructions on this posting. Click the 'Apply' link located on this page to submit your application. For additional instructions on the application process, examinations, Veteran's preference, pre-employment accommodation or other employment questions, please refer to our web site, www.rc-hr.com .

If you are experiencing technical problems, you may contact the governmentjobs.com applicant support desk Monday through Friday, 6 am to 5 pm Pacific Time at support@governmentjobs.com or toll-free 1-855-524-5627.

MEDICAL/DENTAL INSURANCE: A Flexible Benefit Credit is provided on a monthly basis as governed by the Management Resolution or applicable bargaining unit. Vision coverage is provided through Vision Service Plan (VSP) at no cost to employee or eligible dependents.

Note: Employees on assignment through the Temporary Assignment Program (TAP) receive different benefits. See the list here.
MISCELLANEOUS RETIREMENT: County of Riverside has three retirement Tiers through the California Public Employees' Retirement System (CalPERS).

• 
  Tier I (Classic Member - Formula 3% @ 60): Applicable to current and former County of Riverside local miscellaneous employees hired prior to 08/24/2012 and did not withdraw CalPERS contributions. The employee contribution is eight (8%) percent.


• 
  Tier II (Classic Member - Formula 2% @ 60): Applicable to local miscellaneous employees 1) hired after 08/23/2012 through 12/31/2012; 2) Previously employed with another CalPERS contracting public agency or a reciprocal retirement system, with a break in service of less than six months between the separation date with the previous employer and the appointment date with the County of Riverside. The employee contribution is seven (7%) percent.


• 
  Tier III (PEPRA New Member - Formula 2% @ 62): Applicable to CalPERS local miscellaneous new members hired on or after the implementation of the Public Employees' Pension Reform Act of 2013 (PEPRA) which took effect January 1, 2013.Effective July 1, 2023, the employee contributions are 7.25% and will increase to 7.75% effective July 1, 2024.
  

A new member is defined as any of the following:

A new hire who enters CalPERS membership for the first time on or after January 1, 2013, and who has no prior membership in any California Public Retirement System.

A new hire who enters CalPERS membership for the first time on or after January 1, 2013, and who was a member with another California Public Retirement System prior to that date, but who is not subject to reciprocity upon joining CalPERS.

A member who first established CalPERS membership prior to January 1, 2013, and who is rehired by a different CalPERS agency after a break in service of greater than six (6) months.

CalPERS refers to all members that do not fit within the definition of a new member as "classic members".

Contribution rates are subject to change based on the County of Riverside annual actuarial valuation.

Note:

This summary is for general information purposes only. Additional questions regarding retirement formulas can be sent to retirement@rivco.org or by calling the Benefits Information Line at (951) 955-4981,
Option 2.

If you have prior service credit with another CalPERS agency or within agencies, please contact CalPERS at (888) 225-7377 to determine which retirement tier would be applicable to you. CalPERS is governed by the Public Employees' Retirement Law. The Retirement Law is complex and subject to change. If there's any conflict between this summary and the law, the law will prevail over this summary.
DEFERRED COMPENSATION: Voluntary employee contribution with a choice between two 457 deferred compensation plan options.

401(a) MONEY PURCHASE PLAN: County contribution of $50 per pay period towards choice between two 401(a) plan providers.

ANNUAL LEAVE (Bi-Weekly Accrual):

0 < 36 months = 8.92 Hours
36 to <108>108 or more months = 12.00 Hours

Maximum Annual Leave accumulation is 1,800 hours. Employee may receive pay in lieu of up to 80 hours per calendar year. Agency/Department Head may approve an additional 80 hours.

-Annual Leave for Unrepresented Management Attorneys:
Maximum Annual Leave accumulation is 2,000 hours. Refer to Article 22 of the Management Resolution for a list of job classifications included.

HOLIDAYS: Normally 12 paid holidays per year.

BEREAVEMENT LEAVE: 5 days (3 days are County paid; 2 days can be taken through use of accrued leave balances).

BASIC LIFE INSURANCE: $50,000 of term life coverage. Premiums are paid by the County. Additional Supplemental Life plan is available for employee purchase.

LONG-TERM DISABILITY (LTD): Benefit pays 66.67% of earnings to a maximum of $10,000 per month; 30-day waiting period; pays to age 65. Benefit can be coordinated with other available leave balances to provide up to 100% of pay.

POST RETIREMENT MEDICAL CONTRIBUTION: A monthly contribution is made by the County towards retiree health insurance offered through the County as governed by the Management Resolution or applicable bargaining unit.

OTHER: There may be other benefit provisions as specified in the applicable Memorandum of Understanding, Management Resolution, or Salary Ordinance. Please contact the recruiter listed on the job posting directly for more information..

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