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Compliance Specialist - Coding Professional

Implement and maintain Professional Compliance programs in accordance with the Office of Inspector General's work plan, to reduce institutional and individual provider legal and financial risk through education and internal audits.

Educate providers in regarding Professional compliance with government regulations with special attention to Center for Medicare and Medicaid guidelines as they pertain to academic medical centers, HIPAA, and Fraud and Abuse with periodic updates.

Assist in performing analysis of current situations and recommend priorities and goals for future clinic needs. Identify coding and billings risk areas, conduct focused reviews, and implement corrective action as needed.

Conduct routine internal audits of provider documentation on a timely basis. Collaborate with physicians and internal staff in development of improved capabilities in the areas of documentation, coding, and compliance.

Review internal controls, policies, and procedures to ensure compliance with appropriate University, State, and Federal guidelines and policies, sound business and finance practices, and overall clinical goals and objectives.

Respond promptly to external and internal concerns; implementing corrective actions as appropriate.

Communicate with Medicare/Medicaid Carriers and third party payers regarding policies and procedures.

Promote Professional Compliance initiatives with clinical faculty and administration.

Perform other related duties incidental to the work described herein.

Required Qualifications

Education
Work requires organization, analytical and communication skills generally acquired through the completion of a Bachelor's degree program.

Experience
Four years of administrative experience to acquire competence in applying compliance, coding and auditing principles as they relate to insurance billing, collections, consulting, and other revenue cycle related functions.
Candidates must be CPC, CCS, RHIT, RHIA or CPMA certified.

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