What Ethics Compliance contributes to Cardinal Health

Ethics Compliance promotes a culture that encourages ethical conduct and a commitment to compliance. This function implements strategies and processes to ensure adherence to policies, educates and trains employees across the organization, and conducts investigations to resolve ethics and compliance issues.

Ethics Compliance develops and implements strategies and standard operating procedures to promote adherence to internal ethics and compliance policies related to areas such as privacy, HIPAA and FCPA, among others. This job family resolves concerns from business unit leaders and employees and proactively provides guidance and trainings on policies.

Consultant, Ethics Compliance (Audit)

Reporting to the Compliance Director (Director), this position conducts audits to determine organizational integrity of billing for professional (physician) services and/or hospital (technical) services, including: detection and correction of documentation, coding, and billing errors and/or medical necessity of services billed. Particular areas of focus include: evaluation of the adequacy and accuracy of documentation in support of services billed; compliance with other documentation and coding and billing standards; and physician and coder education. This position will also support the Director with scheduling and audit planning, as well as the development and implementation of educational items associated with the auditing process.

Responsibilities

Plans and performs professional compliance department audits to determine accuracy and adequacy of documentation and coding related to physician or hospital (inpatient and outpatient) billing and/or medical necessity reviews.

Evaluates the appropriateness of billed services and procedures based on supporting record documentation and ensures documentation by providers conforms to legal and procedural requirements.

Prepares written reports of audit findings, with recommendations, and presents to appropriate stakeholders; aids in the evaluation of the adequacy of management corrective actions to improve deficiencies; maintains audit records.

Develops and implements compliance training to ensure compliance with federal and state regulations and laws, CMS and other third-party payer billing rules and internal documentation, coding and billing policies and procedures. At the request of the Director, may provide compliance orientation training for new providers as well as Revenue Cycle team members, as needed. Provides feedback and training for physicians and staff regarding coding insufficiencies.

Facilitates assigning of ICD-9 and ICD-10 codes by analyzing patient medical records.

Maintains a functional knowledge of enterprise EMRs, the registration process and charge entry.

Other duties as assigned.

Qualifications

4-8 years experience in physician and/or hospital technical coding/auditing, medical necessity reviews, or related work. Oncology experience preferred.**

Bachelor's degree in Health Information Management, Business or related field preferred.**In lieu of a Bachelor's Degree, an AA or HS Diploma/GED and five (5) additional years of relevant experience will be considered

Must possess an AAPC or AHIMA coding certification (CPC, CCS, CCS-P, COC, or RHIA, etc.). Auditing certification preferred. Working knowledge of evaluation and management and/or hospital facility fee coding and auditing.

Working knowledge of Medicare and Medicaid documentation and coding rules and guidelines; ICD/CPT/HCPCS/DRG/APC documentation coding rules; charge capture and reimbursement methodologies; medical terminology; E/M rules, teaching physician guidelines, and/or medical necessity defense reviews; healthcare compliance audit methodology, principles and techniques; CMS manuals; professional and/or hospital services reimbursement and repayment; confidentiality standards.

Ability to apply documentation and coding rules, laws and regulations and to interpret medical record progress notes, handwritten and electronic chart entries, provider orders and other related documentation.

Prompt and efficient ability to manage shifting priorities, demands and time lines.

Ability to effectively prioritize and execute tasks in a fast-paced, dynamic environment.

Previous Revenue Cycle experience a plus.

Strong communication and presentation skills.

Attention to detail.

Proficiency in MS Word, Excel, PowerPoint, and Outlook.

What is expected of you and others at this level

Applies comprehensive knowledge and a thorough understanding of concepts, principles, and technical capabilities to perform varied tasks and projects

May contribute to the development of policies and procedures

Works on complex projects of large scope

Develops technical solutions to a wide range of difficult problems

Solutions are innovative and consistent with organization objectives

Completes work; independently receives general guidance on new projects

Work reviewed for purpose of meeting objectives

May act as a mentor to less experienced colleagues

Anticipated salary range: $79,300 - $102,800

Bonus eligible: No

Benefits: Cardinal Health offers a wide variety of benefits and programs to support health and well-being.

Medical, dental and vision coverage

Paid time off plan

Health savings account (HSA)

401k savings plan

Access to wages before pay day with myFlexPay

Flexible spending accounts (FSAs)

Short- and long-term disability coverage

Work-Life resources

Paid parental leave

Healthy lifestyle programs

Application window anticipated to close: 5/17/2025 *if interested in opportunity, please submit application as soon as possible.

The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate’s geographical location, relevant education, experience and skills and an evaluation of internal pay equity.

Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.

Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law.

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