COMPLIANCE SPECIALIST-Remote (Durham, NC, US, 27710)
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.
Patient Revenue Management Organization
Pursue your passion for caring with the Patient Revenue Management Organization, which is the fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions for Duke Health.
This position is 100% remote. All Duke University remote workers must reside in one of the following states:
North Carolina, Alabama, Arizona, Connecticut, District of Columbia, Florida, Georgia, Illinois, Iowa, Kentucky, Louisiana, Maine, Michigan, Missouri, Montana, New Hampshire, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Washington.
*Now offering a $10,000 sign-on bonus that will pay out in 4 equal installments over 24 months - 6-month increments.
General Description of the Job Class:
The Compliance Specialist Auditor will perform coding quality audits of inpatient records to assure appropriateness and accurate code assignments in accordance with Center of Medicare and Medicaid (CMS) guidelines and to provide ongoing feedback and identification of the education needs for the providers and staff.
Duties and Responsibilities
PRIMARY FUNCTION: Monthly QA Audits of PB coders.
Monitor data quality and optimal reimbursement to the hospital by performing retrospective quality audits for accurate coding of ICD-10-CM diagnoses or CPT-4 procedures (and appropriate use of modifiers) for professional and outpatient services using Center for Medicare and Medicaid coding guidelines, standards and regulations.
Should be able to adequately utilize coding resources to back up any findings within audit
Responsible for performing medical record reviews to ensure that documentation supports the assigned codes.
Performs focused/integrated audits; when necessary
Serves as subject matter coding expert
Collaborates with outside departments
Serves as the expert for coding questions
Identify coding and billing risk areas, report results to PB Operations for action plan
Analyzes coded records for compliance with federal, state and third party insurer rules and regulations and note trends.
Excellent verbal and written communication
Sets the tone for ethical behavior, actively models ethical behavior to set an example for others
Identifies issues and discusses them in a timely and constructive manner to obtain a rapid and effective resolution
Performs other related duties incidental to the work described herein and other related work as assigned.
HIGHLY SOUGHT AFTER SKILLS:
- HCC coding/auditing
- Multi-Specialty Coding/Auditing
- Examples:
- Interventional Radiology
- Cardiothoracic
- Ortho (Foot and Ankle Specifically)
- Critical Care
- Observation Services
- ED
- Edits/Denials
- Gen Surg
- Trauma
- Peds
- GI
- Anesthesia
- Good work ethic
- Strong sense of responsibility
- Ability to work independently
Required Qualifications at this Level:
Education:
- High School Diploma, required
Experience:
- Four (4) years of coding review experience in applying compliance, auditing and coding principles as they relate to professional coding and billing
- Or equivalent combination of relevant education and/or experience.
Degrees, Licensure, and/or Certification:
- Certified Professional Coder (CPC), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA) and/or Certified Coding Specialist (CCS), required
- Certified Risk Coder (CRC), Certified Professional Medical Auditor (CPMA)- Added bonus credentials
Knowledge, Skills, and Abilities:
Knowledge of:
- ICD-10-CM and CPT/HCPCS coding guidelines to effectively apply