Discover Vanderbilt University Medical Center: Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery, and patient care, VUMC is a community of individuals who come to work each day with the simple aim of changing the world. It is a place where your expertise will be valued, your knowledge expanded, and your abilities challenged. Vanderbilt Health is committed to an environment where everyone has the chance to thrive and where your uniqueness is sought and celebrated. It is a place where employees know they are part of something that is bigger than themselves, take exceptional pride in their work and never settle for what was good enough yesterday. Vanderbilt's mission is to advance health and wellness through preeminent programs in patient care, education, and research.

Organization:

Compliance Operations - VUH

Job Summary:

Applies specialized skills and training independently to evaluate and advise whether professional, outpatient and inpatient hospital documentation meets applicable standards for coverage, accuracy, and completeness as well as coding and general compliance, with the goals of identifying and preventing compliance risk and providing timely and effective education and remediation. Provides hands-on training and day-to-day productivity and quality oversight of Compliance Specialists and Senior Compliance Specialists as well as any external contracted services used by our office for auditing and consulting services.

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** Coding Certification Required... Must have one of the following certs: CPC, CCS, COC, RHIA, RHIT, etc...

KEY RESPONSIBILITIES

• Evaluates internal and external data and documentation to identify patterns, errors, and risk factors, assess potential areas of non-compliance and vulnerability to audit by health oversight agencies and contractors.
• Recommends and assists in the scoping, planning, and design of subject matter review and clinician-focused (structured) review projects
• Serves in a quality assurance role with responsibility for ensuring that auditing and monitoring performed by other individuals, including third-party consultants, is correct, complete and accurate. Escalates issues or concerns
• Performs audits and analyses and assists in the drafting, editing and finalization of OCCI reports resulting from completed subject matter and structured reviews
• Research and analyze issues in response to requests for assistance from the OCCI team and from other VUMC stakeholders. Leads virtual meetings with VUMC clinical and administrative stakeholders to provide education and guidance on documentation, coding, pertinent policy/SOPs, and billing topics.
• Independently perform audit reviews of contracts, systems, processes, documentation and billing.
• Maintains current knowledge of policy, legal and regulatory standards. Attends and participates in subject matter review entrance and exit conferences
• The responsibilities listed are a general overview of the position and additional duties may be assigned.
• Provides hands-on training and day-to-day productivity and quality oversight of Compliance Specialists and Senior
• Compliance Specialists in the department, as well as any external contracted services used by our office for auditing and consulting services.
• Leads efforts to understand, develop and deploy Artificial Intelligence (AI) technology in the review/audit process.
• Works with MDaudit and other vendors to help ensure the tools we utilize are continually evaluated for enhancements that will reduce manual intervention in the audit/review process; improve accuracy of findings and enhance educational materials.

TECHNICAL CAPABILITIES

• Regulatory Compliance (Advanced): Demonstrates knowledge of the appropriate rules and regulations and apply them in difficult, stressful and complex situations. Able to interpret and explain rules and regulations that are ambiguous or unclear. Directs others in interpreting rules and regulations on the job and trains others in them.
• Improvement Methodology (Intermediate): Lead teams in quality and performance improvement methodology, including facilitating opportunity analysis, key driver diagrams, performance measure requirements, and PDSA improvement cycles (EA, FMEA, CTQ)
• Data Procurement (Advanced): Seeking, collecting, transforming, and ensuring quality of data.
• Metadata Analysis (Advanced): Demonstrates the uppermost levels of expertise in data analysis and interpretation.
• Works with teams and organization stakeholders to identify new, innovative methods and tools for incorporation into data analysis practices. Is able to design a complex logical data or object model. Is knowledgeable of enterprise-wide data and object models and can identify areas of reuse. Possesses expert knowledge in the use of CASE tools. Can recommend extensions to a data dictionary or repository to support data analysis. Can specify how data should be transformed for new uses such as data warehousing.
• Communication (Advanced): Clearly, effectively and respectfully communicates to employees or customers.
• Strategic Planning (Intermediate): The ability to define a strategy, or direction, and making decisions on allocating its resources.

Our professional administrative functions include critical supporting roles in information technology and informatics, finance, administration, legal and community affairs, human resources, communications and marketing, development, facilities, and many more.

At our growing health system, we support each other and encourage excellence among all who are part of our workforce. High-achieving employees stay at Vanderbilt Health for professional growth, appreciation of benefits, and a sense of community and purpose.

Core Accountabilities:

Organizational Impact: Executes job responsibilities with the understanding of how output would affect and impact other areas related to own job area/team with occasional guidance. Problem Solving/ Complexity of work: Analyzes moderately complex problems using technical experience and judgment. Breadth of Knowledge: Has expanded knowledge gained through experience within a professional area. Team Interaction: Provides informal guidance and support to team members.

Core Capabilities :

Supporting Colleagues:- Develops Self and Others: Invests time, energy, and enthusiasm in developing self/others to help improve performance e and gain knowledge in new areas.- Builds and Maintains Relationships: Maintains regular contact with key colleagues and stakeholders using formal and informal opportunities to expand and strengthen relationships.- Communicates Effectively: Recognizes group interactions and modifies one's own communication style to suit different situations and audiences. Delivering Excellent Services:- Serves Others with Compassion: Seeks to understand current and future needs of relevant stakeholders and customizes services to better address them.- Solves Complex Problems: Approaches problems from different angles; Identifies new possibilities to interpret opportunities and develop concrete solutions.- Offers Meaningful Advice and Support: Provides ongoing support and coaching in a constructive manner to increase employees' effectiveness. Ensuring High Quality: - Performs Excellent Work: Engages regularly in formal and informal dialogue about quality; directly addresses quality issues promptly.- Ensures Continuous Improvement: Applies various learning experiences by looking beyond symptoms to uncover underlying causes of problems and identifies ways to resolve them. - Fulfills Safety and Regulatory Requirements: Understands all aspects of providing a safe environment and performs routine safety checks to prevent safety hazards from occurring. Managing Resources Effectively: - Demonstrates Accountability: Demonstrates a sense of ownership, focusing on and driving critical issues to closure.- Stewards Organizational Resources: Applies understanding of the departmental work to effectively manage resources for a department/area.- Makes Data Driven Decisions: Demonstrates strong understanding of the information or data to identify and elevate opportunities. Fostering Innovation:- Generates New Ideas: Proactively identifies new ideas/opportunities from multiple sources or methods to improve processes beyond conventional approaches.- Applies Technology: Demonstrates an enthusiasm for learning new technologies, tools, and procedures to address short-term challenges.- Adapts to Change: Views difficult situations and/or problems as opportunities for improvement; actively embraces change instead of emphasizing negative elements.

Position Qualifications:

Responsibilities:

Certifications:

Certified Professional Coder-Hospital - American Academy of Professional Coders

Work Experience:

Relevant Work Experience

Experience Level:

7 years

Education:

Bachelor's (Required)

Vanderbilt Health is committed to fostering an environment where everyone has the chance to thrive and is committed to the principles of equal opportunity. EOE/Vets/Disabled.