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The Compliance Specialist serves as a subject matter expert on billing and coding compliance issues, leads the Compliance Department’s management of external audits and reviews by payors and regulators, and leads the Compliance Department’s monitoring and implementation of regulatory changes affecting billing and coding.
The specialist provides strategic oversight over external audits and reviews, implements process and compliance improvements in response to the findings of audits and reviews, monitors regulatory developments and implements process changes necessary to respond, provide education and training to physicians and other providers. The specialist assists with ongoing chart reviews, assessing billing and coding compliance.
This position reflects a level of experience and expertise to work independently with outside auditors, reviewers, physicians and other providers, in a collaborative environment and at the direction of the Compliance Officer. This position requires extensive interaction with physicians, clinic operations, billing managers and coders, and other departmental personnel engaged in billing and coding activities, including outside auditors and reviewers.
The Compliance Specialist supports the mission of the Compliance Department regarding billing and coding compliance issues to promote compliance with State and Federal regulations, rules, statutes and laws and to detect, correct and prevent violations.
In order to qualify for this role, you must possess:
- One of the following: RHIA, RHIT (current member of AHIMA or AAPC), CCS, CCS-P, CPC, RN or LPN with Coding Certification or equivalent knowledge and experience.
- Strong knowledge of State and Federal laws governing billing and coding practices.
- Proficience in medical terminology.
- Two (2) years direct Compliance (auditing and education) experience, or five (5) years of coding (inpatient or outpatient services)
- Strong presentation skills with minimum of one year of experience in 1:1 and/or small group presentations.
- Excellent written and communication skills and strong influence skills.
- Working knowledge of Word, Excel, PowerPoint and other related computer skills.
- Ability to positively and effectively communicate across a large multi-specialty clinic and multiple stakeholders.
- Ability to organize work efforts and independently manage projects.
- Ability to maintain strict confidentiality of work related issues, all medical and financial information. Proven ability to positively interact with physicians, faculty and other healthcare professionals.
- AA with RHIT, BS/BA (in HIM) with RHIA, or RN or LPN with Coding Certification.
- Working knowledge of PATH requirements.
- Extensive experience with ICD-9, CPT, DSM-IV and HCPCS coding systems.
- Experience with Medicare, Medicaid and third party payer reimbursement.
- Knowledge of PC and ability to create spreadsheets.
- Advanced problem solving skills.
- Ability to interpret statistical data, create and interpret report data, and perform physician profiling and trending.
We offer a competitive salary and excellent benefits and provide you with the opportunity to enhance your career in the exciting field of healthcare through rewarding and challenging assignments and the opportunities for advancement.