[Hiring] Inpatient Coding Compliance Specialist @Duke University

Role Description

Implement and maintain 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 regarding compliance with government regulations, focusing on:
• Center for Medicare and Medicaid guidelines as they pertain to academic medical centers
• HIPAA
• 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 billing 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 to develop improved capabilities in 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 Compliance initiatives with clinical faculty and administration.
• Perform other related duties incidental to the work described herein.

Qualifications

• Education: Bachelor's degree program.
• Experience: Four years of administrative experience in compliance, coding, and auditing principles related to insurance billing, collections, consulting, and other revenue cycle functions.
• For technical coding: Two of the four years of experience with DRG's and APR-DRG's is required.
• Experience in formal teaching of coding is preferred.
• Certifications: RHIA or RHIT or CCS required.
• For professional coding: Specialty coding experience in surgical or E/M coding preferred.
• Certifications: CPC or CCS or RHIT or RHIA or CPMA is required.

Requirements

• Ability to educate providers regarding compliance with government regulations.
• Ability to assist in performing analysis of current situations and recommend priorities and goals.
• Ability to identify coding and billing risk areas and conduct focused reviews.
• Ability to conduct routine internal audits of provider documentation.
• Ability to collaborate with physicians and internal staff.
• Ability to review internal controls, policies, and procedures for compliance.
• Ability to respond promptly to external and internal concerns.
• Ability to communicate with Medicare/Medicaid Carriers and third-party payers.
• Ability to promote Compliance initiatives.

Benefits

• 100% remote position.
• $10,000 sign-on bonus paid out in 4 equal installments over 24 months - 6-month increments.