Position is responsible for full coding compliance for all professional providers as completed through annual or special auditing, education, and follow-up. Compliance Officer will ensure that all new providers are trained, audited for compliance and appropriate follow through with Medical Director is completed. Position is responsible for staff auditing as assigned to ensure compliance of our staff. Will devise an auditing plan, track progress and results and keep Manager updated of all progress. Compliance Officer will review and respond to all CERT, RAC and other pay or audits along with the denial team. Position is responsible for ensuring billing compliance and system stability by working with the IT Team to make sure we are billing properly and meeting established billing requirements.
Job Duties include the following, other duties may be assigned: Complete all 30 day and 90 day provider training as appropriate to ensure compliance. Assist with new provider training as necessary. Audit all new and established providers at least annually or through special audits, provide education and follow up. Work with appropriate Medical Director on any identified issues. Assist with professional coding staff auditing as assigned to ensure staff are competent. Establish an auditing plan, track progress and results and keep Manager updated on all progress. Serves as active member of designated Compliance Committees, Denial Review Committees and/or Revenue Cycle Committees reporting out Compliance numbers. Responsible for reviewing and responding to all CERT, RAC, and other payor audits along with the denial team. Position is responsible for reporting out results of these audits to the various committees.
Competencies: If applicable and not listed below, please refer to the department for required competencies. Employees will be tested on their competency for each area of responsibility that they work upon hire or transition of duties. No additional competencies will be completed unless new duties are assigned or the workflow changes dramatically.
Job Requirements & Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily and must clearly demonstrate all required competencies. The education/experience, certifications, skills, physical demands, and work environment described below further define requirements associated with this position. Reasonable accommodations may be made.
High School Graduate or GED required. Bachelor's degree preferred. Five years of experience with professional billing and coding required.
Certificates, Licenses, Registrations Certified Professional Coder - CPC Certification [or] Certified Coding Associate Coder CCA Certification.
Must hold driver's license and have a car to be able to travel to office locations for training.
Language Skills Ability to read, analyze, interpret, and write reports.
Mathematical Skills Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and percentages for discounts.
Reasoning Ability Ability to define problem, collect data, establish facts, and draw valid conclusions.
Computer Skills Technical knowledge of software preferred. Basic knowledge of communications hardware and software. Must be able to utilize the internet, Word, Excel, Access, and Outlook. Other skills, ability or knowledge Skill in exercising initiative, judgment, problem solving, and decision making. Skill in developing and maintaining effective relationships with employees, managers, physicians, patients, and the general public. Must be able to respect the need for confidentiality when dealing with sensitive information.
Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit the majority of the time but may be required to climb or balance, stoop, kneel, crouch, or crawl; use wrist and hands to finger, handle, or feel; reach with hands and arms; and talk or hear. Walking may include up to 200 yards at a time. The employee may regularly lift and/or move items up to 20 pounds and occasionally lift up to 50 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Typically works in settings that are clean, well-lit and temperature controlled. The noise level in the work environment is usually moderate. Will occasionally travel to and work in areas of high traffic (people and equipment). Works in medium to high stress environment with daily deadlines and frequent interruptions.
Other Requirements Mental and Emotional There are mental and emotional requirements of all positions working in a health care setting due to the nature of the services provided. The requirements include: handling multiple priorities, making decisions under pressure, working in close proximity to others and/or in a distracted environment, managing anger/fear/hostility, managing stress appropriately, working with others effectively, and working alone effectively.
Compliance and Regulatory All employees are required to comply with all laws, regulatory guidelines, and health care policies. This includes, but is not limited to: federal, state and local laws, applicable State Departments of Health, Healthcare Facilities Accreditation Program (HFAP), The Joint Commission, Health Insurance Portability and Accountability Act (HIPAA), and Deaconess Policies and Procedures. All employees are required to be compliant with hand hygiene guidelines as well as adhere to safe practices, identifies and reports unsafe practices.