UNC REX Healthcare
Compliance Analyst Senior - Rex Professional Compliance
UNC REX Healthcare, Chapel Hill, North Carolina, United States, 27517
Description
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Summary:
Responsible for assisting Compliance management in all compliance activities which could include reviewing internal processes, documents and reports, and ensuring compliance with internal and external regulatory framework. Serves as an expert resource to physicians, coders and reimbursement analysts across UNC Health Care. May supervise compliance staff.
Responsibilities
Auditing and Monitoring – Stays current with changing regulations, policies, procedures, standards and coding guidelines. Identifies and analyzes areas of weakness, researches causes and formulates recommendations to enhance operations and compliance. Familiarizes self with area under review, and if necessary, visits department/facility to gain operational and process knowledge. Researches all relevant materials including regulations, policies, procedures, CPT coding guidelines and CMS policies. Assists in preparing annual audit and work plan. Performs work outlined in work plan. Obtains and analyzes data. Identifies and evaluates the area under review, identifying and documenting areas of risk and vulnerability related to non-compliance. Assists in development of new policies and procedures and audit tools. Performs E/M and Procedural coding audits. Analyzes audit findings and reports/tracks results for one-on-one or group feedback. Performs billing audits and ensures correct coding and billing compliance. Documents audit work and findings in accordance with department standards. Provides communication of audit findings to department leadership as directed by management. Seeks opportunities to improve and enhance professional compliance in areas such as coding, clinical documentation, charge capture, and EPIC. The auditor should be familiar with clinical documentation and charge capture methodologies.
Customer Service – Provides courteous and friendly service. Develops productive working relationships with all levels of management, staff and providers. Identifies and resolves barriers. Participates in committee work, workshops and cross-functional teams. Facilitates meetings where information is shared with operational departments concerning new regulations, billing requirements and other compliance activities. Provides one-on-one and/or group meetings with providers regarding coding/compliance education. Assists with the development and delivery of appropriate compliance training and education across the UNC Health Care System. Serves as an expert resource to physicians, coders and reimbursement analysts. Responds to inquiries on how best to code, document and bill for services provided.
Investigations – Familiarizes self with area under review. Researches and gathers relevant materials including regulations, policies, procedures, coding guidelines, and CMS rules. Conducts interviews to understand operational workflows and assess compliance issues and risk. Performs data collection and analysis. Documents findings and provides an analysis with recommendations. Works with departmental leaders on corrective action plans.
Professional Development – Maintains current knowledge of CPT and ICD coding guidelines as well as CMS policy and regulations. Reads trade journals/articles related to coding and compliance and shares knowledge with peers and customers.
Special Projects – Performs special projects as requested by management.
Supervision – May supervise compliance staff.
Other Information Education Requirements: Bachelor’s degree in Accounting, Business Administration, Health Administration, Nursing or related field (or equivalent combination of education, training and experience).
Licensure/Certification Requirements: Coding certification (e.g., CPC, CCS-P)
Professional Experience Requirements:
• If a Bachelor’s degree: Three (3) years of experience in business, health care, coding, revenue cycle, legal, regulatory compliance, or a supervisory role in Revenue Cycle or HIM. • If an Associate’s degree: Seven (7) years of experience in business, health care, coding, revenue cycle, legal, regulatory compliance, or a supervisory role in Revenue Cycle or HIM.
• If a High School diploma or GED: Eleven (11) years of experience in business, health care, coding, revenue cycle, legal, regulatory compliance, or a supervisory role in Revenue Cycle or HIM.
Knowledge/Skills/and Abilities Requirements:
• Advanced and demonstrated ability to research regulations and understand professional billing and reimbursement methodologies. Must be familiar with reference sources and able to navigate and link various sources of regulations and standards. Interpret billing compliance and other regulations and apply to specific situations. • Advanced understanding of clinical and revenue cycle operations. Demonstrates understanding of the operating environment and how operations and productivity interface with regulatory requirements. • Advanced knowledge of Professional Compliance Program requirements. Ability to understand, demonstrate, and teach professional compliance, billing and coding compliance to others. Ability to gather evidence, analyze data and develop recommendations. • Advanced data analysis and critical thinking skills. • Advanced Microsoft Applications proficiency with the ability to use graphs, pivot tables, and formulas. Ability to create Visio flow charts. • Must have advanced presentation skills. Ability to educate physicians, mid-level providers, support staff and administration on medical record documentation requirements as set forth by Federal Documentation Guidelines and other compliance education areas. Ability to transfer technical coding and billing information to non-technical users. • Advanced organizational skills with the ability to manage multiple projects and deadlines. Provides source materials to physicians and others and delivers exceptional customer service. • Ability to work with others in a respectful manner. Demonstrates a positive attitude and maintains professional conduct, appearance and language. Is tactful and respectful in communication. • Advanced ability to advise management and departmental stakeholders on compliance issues and risk. Ability to listen carefully and follow directions; seek clarification when needed. • Possesses advanced knowledge of CPT, ICD-9 and ICD-10 coding. Interprets inpatient and outpatient services for medical specialties using knowledge of anatomy, physiology, medical terminology and reimbursement methodologies. Excellent verbal and written communication skills. Must express thoughts clearly and transfer knowledge to others. Must be able to interview staff to understand operational processes and areas of concern.
Job Details Legal Employer: NCHEALTH
Entity: Shared Services
Organization Unit: Rex Professional Compliance
Work Type: Full Time
Standard Hours Per Week: 40.00
Salary Range: $30.73 - $44.18 per hour (Hiring Range)
Pay offers are determined by experience and internal equity
Work Assignment Type: Hybrid
Work Schedule: Day Job
Location of Job: US:NC:Chapel Hill
Exempt From Overtime: Exempt: Yes
This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System. This is not a State employed position.
Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.
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Summary:
Responsible for assisting Compliance management in all compliance activities which could include reviewing internal processes, documents and reports, and ensuring compliance with internal and external regulatory framework. Serves as an expert resource to physicians, coders and reimbursement analysts across UNC Health Care. May supervise compliance staff.
Responsibilities
Auditing and Monitoring – Stays current with changing regulations, policies, procedures, standards and coding guidelines. Identifies and analyzes areas of weakness, researches causes and formulates recommendations to enhance operations and compliance. Familiarizes self with area under review, and if necessary, visits department/facility to gain operational and process knowledge. Researches all relevant materials including regulations, policies, procedures, CPT coding guidelines and CMS policies. Assists in preparing annual audit and work plan. Performs work outlined in work plan. Obtains and analyzes data. Identifies and evaluates the area under review, identifying and documenting areas of risk and vulnerability related to non-compliance. Assists in development of new policies and procedures and audit tools. Performs E/M and Procedural coding audits. Analyzes audit findings and reports/tracks results for one-on-one or group feedback. Performs billing audits and ensures correct coding and billing compliance. Documents audit work and findings in accordance with department standards. Provides communication of audit findings to department leadership as directed by management. Seeks opportunities to improve and enhance professional compliance in areas such as coding, clinical documentation, charge capture, and EPIC. The auditor should be familiar with clinical documentation and charge capture methodologies.
Customer Service – Provides courteous and friendly service. Develops productive working relationships with all levels of management, staff and providers. Identifies and resolves barriers. Participates in committee work, workshops and cross-functional teams. Facilitates meetings where information is shared with operational departments concerning new regulations, billing requirements and other compliance activities. Provides one-on-one and/or group meetings with providers regarding coding/compliance education. Assists with the development and delivery of appropriate compliance training and education across the UNC Health Care System. Serves as an expert resource to physicians, coders and reimbursement analysts. Responds to inquiries on how best to code, document and bill for services provided.
Investigations – Familiarizes self with area under review. Researches and gathers relevant materials including regulations, policies, procedures, coding guidelines, and CMS rules. Conducts interviews to understand operational workflows and assess compliance issues and risk. Performs data collection and analysis. Documents findings and provides an analysis with recommendations. Works with departmental leaders on corrective action plans.
Professional Development – Maintains current knowledge of CPT and ICD coding guidelines as well as CMS policy and regulations. Reads trade journals/articles related to coding and compliance and shares knowledge with peers and customers.
Special Projects – Performs special projects as requested by management.
Supervision – May supervise compliance staff.
Other Information Education Requirements: Bachelor’s degree in Accounting, Business Administration, Health Administration, Nursing or related field (or equivalent combination of education, training and experience).
Licensure/Certification Requirements: Coding certification (e.g., CPC, CCS-P)
Professional Experience Requirements:
• If a Bachelor’s degree: Three (3) years of experience in business, health care, coding, revenue cycle, legal, regulatory compliance, or a supervisory role in Revenue Cycle or HIM. • If an Associate’s degree: Seven (7) years of experience in business, health care, coding, revenue cycle, legal, regulatory compliance, or a supervisory role in Revenue Cycle or HIM.
• If a High School diploma or GED: Eleven (11) years of experience in business, health care, coding, revenue cycle, legal, regulatory compliance, or a supervisory role in Revenue Cycle or HIM.
Knowledge/Skills/and Abilities Requirements:
• Advanced and demonstrated ability to research regulations and understand professional billing and reimbursement methodologies. Must be familiar with reference sources and able to navigate and link various sources of regulations and standards. Interpret billing compliance and other regulations and apply to specific situations. • Advanced understanding of clinical and revenue cycle operations. Demonstrates understanding of the operating environment and how operations and productivity interface with regulatory requirements. • Advanced knowledge of Professional Compliance Program requirements. Ability to understand, demonstrate, and teach professional compliance, billing and coding compliance to others. Ability to gather evidence, analyze data and develop recommendations. • Advanced data analysis and critical thinking skills. • Advanced Microsoft Applications proficiency with the ability to use graphs, pivot tables, and formulas. Ability to create Visio flow charts. • Must have advanced presentation skills. Ability to educate physicians, mid-level providers, support staff and administration on medical record documentation requirements as set forth by Federal Documentation Guidelines and other compliance education areas. Ability to transfer technical coding and billing information to non-technical users. • Advanced organizational skills with the ability to manage multiple projects and deadlines. Provides source materials to physicians and others and delivers exceptional customer service. • Ability to work with others in a respectful manner. Demonstrates a positive attitude and maintains professional conduct, appearance and language. Is tactful and respectful in communication. • Advanced ability to advise management and departmental stakeholders on compliance issues and risk. Ability to listen carefully and follow directions; seek clarification when needed. • Possesses advanced knowledge of CPT, ICD-9 and ICD-10 coding. Interprets inpatient and outpatient services for medical specialties using knowledge of anatomy, physiology, medical terminology and reimbursement methodologies. Excellent verbal and written communication skills. Must express thoughts clearly and transfer knowledge to others. Must be able to interview staff to understand operational processes and areas of concern.
Job Details Legal Employer: NCHEALTH
Entity: Shared Services
Organization Unit: Rex Professional Compliance
Work Type: Full Time
Standard Hours Per Week: 40.00
Salary Range: $30.73 - $44.18 per hour (Hiring Range)
Pay offers are determined by experience and internal equity
Work Assignment Type: Hybrid
Work Schedule: Day Job
Location of Job: US:NC:Chapel Hill
Exempt From Overtime: Exempt: Yes
This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System. This is not a State employed position.
Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.
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