Department – Compliance
- Develops and implements processes related to coding, billing, and medical record documentation that support the system-wide compliance program by: developing and implementing content for compliance education and training; conducting and overseeing compliance audits and investigations; conducting training and developing policies and procedures related to revenue cycle compliance matters; and serving as the in-house expert on medical center billing, coding, and medical record documentation compliance issues.
- Collaborates with key leadership, other employees, contractors, and independent physicians to identify, research, investigate and resolve compliance issues related to the medical center revenue cycle.
- Oversees and documents external regulatory investigations and audits related to revenue cycle compliance.
- Monitors, analyzes, interprets, and communicates regulatory changes related to coding, billing, and medical record documentation. Leads and oversees efforts to respond to new or changing regulations, including but not limited to communicating regulations to site leadership and affected departments, assembling and chairing work teams, and developing/providing education regarding regulatory requirements.
- Performs follow-up to ensure repayment of all identified overpayments received from health plans and patients.
- In collaboration with compliance leadership, develops and/or oversees compliance policies and procedures related to the medical center revenue cycle.
- Tracks data and creates reports to assist in the analysis of compliance issue patterns.
- Reduces organization risk by identifying risks related to the revenue cycle and by developing and managing an annual work plan to address those identified risks.
- Creates and delivers education related to revenue cycle compliance, using on-line training courses, in-person educational presentations, guideline documents, newsletters, the Compliance website and other educational tools.
- Works with Human Resources to investigate suspected employee misconduct and determine appropriate discipline for employees found to have committed compliance violations.
- Leads and/or participates in projects related to the design, implementation, revision and maintenance of processes and systems that promote compliance related to the revenue cycle.
- Chairs and/or participates in committees related to revenue cycle compliance
- Serves as internal expert and advisor in compliance matters related to coding, billing, documentation, and the legal medical record.
- Performs other duties as assigned or as necessity dictates.
- Knowledge of medical center billing and clinical health care practices equivalent to that which would be acquired by completing a regionally accredited bachelor’s degree program.
- Knowledge, skills and abilities required to perform this job are typically acquired through a minimum of five years of progressively responsible experience within a health care environment that includes experiences in planning and implementing large scale projects that affect multiple departments and functions; implementing regulatory changes; identifying, investigating, and resolving complaints; and analyzing and interpreting medical center billing requirements.
- Advanced knowledge of ICD and CPT coding.
- Knowledge of processes related to billing, including but not limited to Local and National Coverage Decisions, Advanced Beneficiary Notices, Medicare Secondary Payor questions, and write-offs
- Strong planning, problem-solving and change management skills. Demonstrated leadership skills and abilities, including the ability to lead diverse work teams.
- Demonstrated personal traits of a high level of motivation, team orientation, professionalism and trustworthiness, and placing a high value on treating others with dignity and respect.
- Strong written and oral communication skills.
- Strong skills in personal diplomacy with demonstrated ability to handle sensitive communications with leadership, physicians, management, legal counsel and regulatory agencies.
- Strong organizational and time management skills.
- Demonstrated proficiency in the Microsoft office (Word, Excel, and PowerPoint) or similar products