This role is directly responsible for the management and execution of multiple data science and data analytics projects in support of compliance and ethics initiatives. Projects range in scale and includes medium and large-scale projects and project variety ranges from internally generated queries to external (third party and governmental) inquiries.
Essential Functions
* Develops and manages the prospective and retrospective compliance documentation audits program.
* Designs tools and methodologies for conducting audits. Tracks and trend result of audits. Track and analyze physician coding patterns and documentation.
* Prepares and presents reports on audit results, and maintains adequate documentation related to such and maintains integrity of the documentation whether in paper or electronic format.
* Prepare written reports summarizing compliance audits or monitoring activities, for review, and approval.
* Develop, prepare and present reports related to compliance trends and metrics.
* Participate in the development and implementation of the annual compliance risk assessment and work plan as it relates to coding, billing, documentation initiatives.
* Reviews the implementation of corrective action plans. Identifies trends in billing, coding and documentation errors and recommends corrective action plans. Monitors implementation and effectiveness of corrective action plans. Development of automated monitoring tools to provide ongoing analysis of coding distributions and changes and red flag triggers.
Additional Responsibilities
Required For All Jobs