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Posted: 26-Feb-25
Location: Morrisville, North Carolina
Categories:
Internal Number: 9999-INFOR-159925
Description
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Summary:
Responsible for assisting Compliance management in compliance activities which could include reviewing internal processes, documents and reports, and ensuring compliance with internal and external regulatory framework. Serves as a resource to physicians, coders and reimbursement analysts across UNC Health Care.
Responsibilities:
1. Auditing and Monitoring - Stays current with changing regulations, policies, procedures, standards and coding guidelines. The individual effectively identifies and analyzes areas of weakness, research causes and formulate recommendations that 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 but not limited to regulations, policies, procedures, and other standards such as 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. Provides one-on-one or group education. Performs billing audits and ensures correct coding and billing compliance. Assists with RAC audits and review of other outside requests as directed. Documents audit work and findings in accordance with department standards. During the audit and monitoring process, identifies and analyzes areas weaknesses, research causes, and formulate recommendations back to the appropriate department. Provides communication of audit findings to department leadership as directed by management. The auditor should be familiar with basic clinical documentation and charge capture methodologies.
2. Customer Service - Provides courtesy and friendly service. Develops productive working relationships with all levels of management, staff and providers. Identifies and seeks resolution to barriers. Demonstrates customer service qualities that instill confidence. Mentors others on how to provide the highest level of customer service. Effectively follows up and closes all issues assigned or identifies issues to management with recommendations on how to proceed. Conducts and/or facilitates meetings where information is shared with operational departments concerning new regulations, billing and other compliance activities or other standards. Assists with the development and delivery of appropriate compliance training and education across the UNC Health Care System. Serves as a resource to physicians, coders and reimbursement analysts. Responds to inquiries on how best to code, document and bill for that impact professional compliance. Communicates openly and effectively with team members and management.
3. Investigations - Investigates, questions, gathers data, integrates and interprets data with the intent to report information and provide an analysis and recommendation of findings. Familiarizes self with area under review. Researches and gathers all relevant materials including but not limited to regulations, policies, and procedures, coding guidelines, and CMS rules regulations. Conducts interviews understanding operational workflows in order to thoroughly assess compliance issues and risk. Performs data collection and analysis. Documents findings in accordance with department standards, communicates findings as directed by management and provides an analysis of findings with recommendations. Works with departmental leaders on corrective action plans.
4. 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.
5. Special Projects - Performs special projects as requested by management as needed or assigned.
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) within eighteen (18) months from date of hire.
Professional Experience Requirements:
? If a Bachelor's degree: No prior experience required.
? If an Associate's degree: Four (4) years of relevant experience.
? If a High School diploma or GED: Eight (8) years of relevant experience.
Knowledge/Skills/and Abilities Requirements:
? Basic to Intermediate and demonstrated ability to research regulations and understand professional billing and reimbursement methodologies. Must maintain current knowledge of governmental policies such as local and national coverage decisions and CMS rules and regulations. Intermediate knowledge of clinical documentation, coding and billing. Must be familiar with reference sources and have the ability to navigate and link various sources of regulations and standards. Must be able to interpret billing compliance and other regulations and apply them to specific situations or scenarios. Basic to Intermediate understanding and demonstrated ability of clinical and revenue cycle operations. Must demonstrate an understanding of the operating environment and how these operations and the demands of productivity interface with regulatory requirements. Basic to Intermediate knowledge of the Professional Compliance Program requirements. Ability to gather evidence, analyzes data, and develops recommendations. Intermediate level of knowledge, skills and abilities with regard to listening, communicating and presenting materials. Demonstrates and teaches professional compliance and billing and coding compliance to others. Intermediate Microsoft Application Proficiency with the ability to use graphs, pivot tables, and formulas. Ability to create Visio flow charts. Intermediate proficiency with applications required for area of expertise, data extraction and data analysis. Intermediate data analysis and critical thinking skills. Ability to organize, analyze and interpret data and evidence, communicate findings and make recommendations. Intermediate to Advanced research skills and consistently demonstrates going above and beyond to find solutions. Requires excellent verbal and written communication skills. Clearly express thoughts and ideas and must possess the ability to effectively transfer knowledge to others. Must be able to interview staff to understand operational processes and areas of concern. Written communication is clear, concise and professional. Must have Intermediate to advanced presentation skills with the ability to present findings and answer questions. Ability to translate technical coding, billing, and regulatory information and knowledge to non-technical users. Advanced organizational skills with the ability to manage multiple projects and multiple deadlines in a positive manner. Basic ability to advise management and departmental stakeholders on compliance issues and risk. Must have advanced ability to listen carefully and follow directions. Asks for clarification and seeks guidance when needed. Prefer knowledge of CPT, ICD 9 and ICD 10 coding. Prefer health care business knowledge and knowledge of anatomy, physiology, medical terminology and reimbursement methodologies. Serves as a support resource to physicians and others, provides exceptional customer service. Advanced ability to work with well others and conduct work in respectful manner. Communicates clearly and positively in all forms of communication, demonstrates team work and follows the normal business protocol. Demonstrates a positive attitude. Maintains appropriate professional conduct, appearance and language. Is tactful and respectful in communication. Ability to lead others and serve as a mentor to peers.
Job Details
Legal Employer: NCHEALTH
Entity: Shared Services
Organization Unit: Physician Compliance
Work Type: Full Time
Standard Hours Per Week: 40.00
Salary Range: $28.59 - $41.09 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:Morrisville
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 Heath 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.
