Compliance Specialist II

Description

JOB SUMMARY

• Increased responsibility for conducting audits of PPG Providers to ensure accuracy of coding and documentation. Identifies and evaluates compliance risk areas. Performs focused and/or investigational audits. Develops recommendations to reduce compliance risks and assists with resolution of any compliance issues. Assists with Policy and Procedures development related to coding. Monitors trends; makes applicable adjustments to policies, resources, and training programs. Prepares coding education materials; provides education to PPG Providers based on chart reviews and other focused/investigational audits. Maintains coding certification and knowledge of current coding trends. Keeps up-to-date of all billing and coding regulatory rules and regulations.

GENERAL REQUIREMENTS

• Maintains and applies knowledge of regulations and regulatory changes relevant to the industry and the organization – CMS, DCH and others.


• Maintains confidentiality and discretion regarding all work matters. Performs all duties in a manner that protects the confidentiality of patients, employees, and business matters and does not solicit or disclose any confidential information unless it is necessary in the performance of assigned job duties.


• Displays problem solving ability, initiative, reasoning ability, decision making techniques, and appropriate use of resources.


• Provide the highest possible level of service to clients.


• Promote teamwork and cooperative effort among employees.

WORKING CONDITIONS

• General environment: Works in a well-lighted, air-conditioned area, with moderate noise levels.


• May be required to change from one task to another of different nature without loss of efficiency or composure.


• Periods of high stress and fluctuating workloads may occur.

Qualifications

EDUCATION REQUIREMENTS

• 2 year / Associate Degree in a related field; in lieu of a Associate Degree; a High School Diploma with 6 years of relevant experience is acceptable (Required)
  

EXPERIENCE REQUIREMENTS

• 2 years of directly related experience (Required)
  
• Strong knowledge of CPT, CDM, DRG, and billing and clinical operations (Required)
  
• Overall knowledge of hospital department or physician practice operations (Required)
  
• No Degree: Total of 6 years of directly related experience in the healthcare industry, medical coding, internal audit, financial, legal, compliance, or government programs (Required)
  

CERTIFICATIONS AND LICENSURES

• Other related, advanced certifications (Preferred)
  
• Certified Professional Coder (CPC) and Certified Professional Medical Auditor (CPMA) certifications OR Certified in Healthcare Compliance (CHC) and HCCA Certified in Healthcare Privacy Compliance (CHPC) certifications (Required)
  

GENERAL SKILLS

• Organizational Skills
  
• Communication Skills
  
• Interpersonal Skills
  
• Customer Relations
  
• Analytical
  
• Grammar / Spelling
  
• Read / Comprehend Written Instructions
  
• Follow Verbal Instructions
  
• Basic Computer Skills
  
• Coding software, such as EncoderPro and Intelicode.
  

PHYSICAL REQUIREMENTS

• Have near normal vision - Clarity of vision (both near and far), ability to distinguish colors
  
• Have good - manual dexterity and eye-hand-foot coordination
  
• Ability to perform - repetitive tasks/motion
  

PHYSICAL DEMANDS

• Standing - Occasionally within shift (1-33%)
  
• Walking - Occasionally within shift (1-33%)
  
• Sitting - Frequently within shift (34-66%)
  
• Bending/Stooping - Occasionally within shift (1-33%)
  
• Reaching above shoulder - Occasionally within shift (1-33%)