JOB DESCRIPTION:
Position Summary:
The Coding and Reimbursement Specialist plans, organizes, performs, and reports on compliance auditing and monitoring activities for Via Christi Health System. Audits are based on the OIG (Office of Inspector General) annual work plans, federal regulations and compliance requirements, issues identified through internal compliance risk assessments, and issues reported by employees or associates. The Specialist is knowledgeable of coding principles, medical record documentation guidelines, and billing and reimbursement requirements.
Key Responsibilities:
* Collaborates with Corporate Responsibility Officers, Internal Auditors, Risk Management, and other management personnel to identity areas with greatest potential of non-compliance with governmental regulations and internal requirements.
* Creates and maintains audit work plan detailing areas to be audited, objectives, scope, and timelines.
* Works closely with CHAN to ensure auditing and monitoring activities complement plans and work being carried out by the Internal Auditors.
* Plans and performs comprehensive compliance audits following the work plan. Maintains documentation of methods used, individuals involved, identified issues, corrective actions taken, and improvements implemented.
* Creates and presents final audit reports to appropriate management and committees.
* Participates in charge master reviews and other coding reviews.
* Works in conjunction with the Corporate Responsibility Coordinator of Education to develop training required as a result of audit outcomes.
* Has knowledge and understanding of organizational policies and procedures, billing and reimbursement requirements, and other regulations that affect operations.
* Reviews new and revised healthcare laws and regulations pertaining to compliance.
* Assists with day-to-day operations of the Corporate Responsibility Program to maintain compliance with laws and regulatory requirements.
* Other duties as assigned by the Director or Vice President of Corporate Responsibility.
JOB REQUIREMENTS:
Knowledge, Skills and Abilities:
* College degree required.
* Coding certification required.
* Experience in health care auditing, compliance, risk assessment, quality assurance, or similar field. CPT and ICD-9-CM expertise.
* Awareness of healthcare regulatory trends.
* Demonstrated knowledge of Medicare and Medicaid reimbursement, fraud and abuse laws, and Conditions of Participation.
* Understanding of audit procedures (date collection, sampling methodologies, etc.)
* Strong interpersonal and communication skills.
* Clear, concise, and persuasive writing and presentation skills.
* Demonstrates unwavering personal and organizational ethical standards.
* Strong orientation to deadline and detail.
* Decisive and capable of exercising good judgment under pressure.
* Ability to manage a diverse and demanding workload.
* Word processing PC skills, knowledge of PowerPoint and Excel
* A personal presence which is characterized by a sense of honesty, integrity and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals and values of Via Christi Health System.
Physical Requirements
* Must be able to travel to Via Christi Health System ministry locations.
* Must be able to adapt to frequently changing work parameters.
Via Christi
|
