Compliance Audit Specialist - Procedural (CPC)

Expiring today

Recruiter
Spartanburg Regional Healthcare System
Location
Spartanburg
Salary
Competitive
Posted
13 Apr 2021
Closes
07 May 2021
Job role
Audit
Sector
IT/Telecoms
Contract type
Permanent
Hours
Full time
In conjunction with the Director of Corporate Integrity and the Senior Compliance Audit Specialist Procedural (SCASP) the Compliance Audit Specialist – Procedural, serves in a support and consultative role to the organization for all aspects of provider and coder, coding, billing and education. The position enhances provider and coder performance of documentation, coding and billing compliance through; auditing, monitoring and analysis of billing patterns, ongoing and routine audits and comprehensive, advisory and educational support. The position operates in partnership with clinical providers and coders, medical directors, leadership, and other internal and external customers. By providing oversight and expertise in documentation, coding, billing and regulations, this position is integral to and directly influences the success of the organization's provider and coder billing compliance and the organization's Compliance Program, Corporate Integrity Department initiatives and annual work plan.Education Required: High School Diploma or equivalent required. Preferred: Bachelor's degree preferredExperience Required: Minimum 1–3 years coding/billing for provider medical services Preferred: 4 or more years of experience Additional Requirements: Certification from the American Academy of Professional Coders (AAPC) Certified Professional Coder (CPC) or Certified Coding Specialist (CSS) requiredRegistered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) highly desirableExemplary written and oral communication skills; ability to navigate challenging conversations and provide effective provider education requiredStrong computer skills including proficiency with Microsoft Office products including Word, Excel, PowerPoint and Outlook requiredAdditional software experience with EPIC, University, 3M Encoder and other coding related tools desirableExtensive knowledge and proficiency of CPT & ICD–10–CM guidelines requiredExperience with professional fees auditing, monitoring, and analysis including provider utilization, statistical risk assessment and report development preferredExperience with presenting and training of Procedural coding guidelines and coding preferredSelf–directed and ability to work well both independently and with othersLicense/Registration/Certifications Required: CPC or CCS Core Job ResponsibilitiesWorks directly with the Director of Corporate Integrity, VP Corporate Integrity, Senior Compliance Audit Specialist(s), medical directors, the organization's leadership and others to provide leadership, oversight and direction to ongoing activities related to procedural coding servicesOversees, directs and monitors the development, implementation, and maintenance of the organization' s procedural coding auditing and monitoring policies and proceduresServes as the organization's authoritative, content expert related to procedural coding servicesMonitors organizational, governmental, agency and other news and publications to stay informed and knowledgeable in E services, HCPCS, CPT and ICD–10, as appropriateAnalyze and validate procedural coding compliance for providers through analysis of billing and utilization patterns, perform routine and focus audits and develop comprehensive educational sessions to improve performance based on the findings, as appropriatePrepares scripts to electronically query specific data elements available from software applications to collect and analyze complex data of providers' coding, billing and utilization patternsDevelops methodologies to assess data elements to support E compliance for providers through analysis of billing and utilization patterns, performs routine and focus audits and develops comprehensive educational sessions to improve performance based on the findings, as appropriate Develop risk assessment and management strategies that support the organization's compliance audit planCollaborate with the organization to evaluate appropriate documentation, coding and billing and recommend, develop or research tools and information to support these activitiesProvides evaluation and resolution, with authority, of complex reimbursement issues and inquiries originating from the professional billing staff, coding staff, patients and other internal and external customersAct as content experts related to specific procedural coding matters through research, review and development of comprehensive education and training programsProvide periodic education and training with regard to National Correct Coding Initiatives and other industry recognized procedural coding standardsAssist in the development, review and revisions of pertinent auditing and monitoring plans, action plans and education plans based on audit findings, audit outcomes, industry trends, government and other oversight notices and other internal and external factors, as appropriateAct as a consultant to internal and external customers regarding provider documentation, coding and billing, as appropriateSupports compliance and disseminates information to improve awareness and modify policies as neededDirects and or Attends compliance and related meetings as appropriateAssists in other matters, as directedReports and or presents compliance data, documentation and other information, as requested or needed, to the Director of Corporate Integrity, the VP Corporate Integrity, executive leadership or management as designatedDevelops and oversees the implementation of corrective action plans that result from auditing and monitoring activitiesDevelops and implements procedural coding educational programs and tools for resident physicians Initiates, facilitates and promotes activities to foster procedural coding compliance awareness within the organization and related entitiesAdministers the process for receiving, documenting, tracking, investigating, and taking action on all complaints concerning the organization's procedural coding compliance and resolves customer concerns and complaints regarding specific procedural coding services and provides supporting information to providers, practices and patient financial services, as appropriateMaintains current knowledge of applicable federal and state procedural coding laws and associated standards, and monitors changes and new developments to ensure organizational adaptation and complianceMonitors the OIG's work plan, CMS and other regulatory agencies' and current industry standards relative to procedural coding focus audit activitiesAnalyzes auditing and monitoring outcomes and develops initiatives and feedback for the annual Compliance Plan based on identified risks

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