The Internal Audit Department provides an independent appraisal function to validate management control systems, assess risk, and 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 test the medical records and corresponding bills, and processes/systems 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 federal regulatory requirements. The team works closely with facility, division, and group management personnel as well as corporate executives. Position reports to the Director of Clinical Compliance, Internal Audit.
- Conducts reviews of hospital/center systems to ensure compliance with applicable legal regulatory requirements as defined by federal and state regulations and company policy.
- Develops detailed reports specifying compliance issues identified during the audit.
- Assists the facility with action plan development and follow-up questions as necessary.
- Demonstrates a thorough understanding of federal and state regulations and Joint Commission standards regarding review areas.
- Discusses complex auditing issues with engagement team and client management.
- Participates in the audit quality assurance program.
- Communicates (clearly) 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’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 in the review of the detailed audit/review programs, processes, controls, and transactions.
- Executes audit procedures, analyzes evidence, reaches conclusions, identifies issues, develops strategies, and makes decisions for complex, judgmental issues in conjunction with the director, related to the review procedures executed. Consults with others in the Company, in conjunction with the director, as necessary, on complex issues.
- Enters/reviews working papers and memoranda into Teammate per 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 AREAS REVIEWED
- National Coverage Determination, (Carotid Stents, Implantable Cardiac Defibrillators, Pacemakers, others).
- Medicare Admission status, “Pay for Performance” measures including Core Measures, and National Healthcare Safety Network, others.
- Privileged and Non-Privileged Licensure/Certification, and Telehealth.
- Pharmacy Compounding, Controlled Substances, High Alert Medications, others.
- Post-Acute Services: Inpatient/Outpatient Rehabilitation, Inpatient/Outpatient Psychiatric Services, Clinical Research, others