Regional Compliance Specialist
I. POSITION SUMMARY:
Under the direction of the Chief Compliance Officer, the Regional Compliance Specialist will coordinate and support compliance functions and activities in support of enabling Sound Physicians providers to comply with all applicable billing and privacy compliance regulations.
The Regional Compliance Specialist contributes to compliance program development by maintaining data for program reports, participating in the development and/or delivery of educational and outreach materials, and maintaining program records. The Compliance Specialist will maintain current knowledge of applicable laws and regulations and may contribute to the unit’s risk assessments and risk mitigation strategies.
The Regional Compliance Specialist functions as part of a unit team to accomplish unit goals, and work cooperatively with other compliance staff and entity staff as needed to resolve shared issues and concerns. In addition, he or she may participate in committees, workgroups, or process improvement projects as assigned.
The Regional Compliance Specialist is responsible for audits that assess the accuracy of documentation, coding, and billing against federal regulations (Medicare) and other laws and state laws and regulations that may apply. Develops, maintains and presents coding and compliance training and educational materials for existing Sound Physicians’ providers and staff as well as providing on-site training for new Sound locations.
II. ESSENTIAL DUTIES AND RESPONSIBILITIES:
• The Regional Compliance Specialist conducts audits and/or analyzes data, prepares reports pursuant to the Compliance Program’s annual audit plan, and participates in the development and implementation of follow-up education, outreach, and/or other corrective actions.
• Responsible for training Sound Physicians’ providers and staff on coding and compliance guidelines and documentation requirements. Examples of training and educational materials include: new staff orientation, new provider training, compliance newsletter, specialized coding and compliance training, new policies and procedures and Teaching Physician rules.
• Assists in determining training needs based on compliance audits and provider/staff feedback and prepares training materials with the assistance of internet research, publications and professional networking.
• Coordinates training in an organized, professional manner. May provide training as part of implementing corrective actions.
• Assists in the development and implementation of policies and procedures related to coding and compliance and actively supports operational and compliance objectives.
• Advises the Vice President of Compliance on matters relating to technical billing, coding, or regulatory requirements for documenting, coding, and billing for health care services.
• Responds to coding and compliance questions from faculty, coding staff, administrators and others.
III. STANDARD JOB RESPONSIBILITIES
• Conduct business with employees, patients, the physicians and outside parties in a professional appropriate manner conducive to maintaining good working relations.
• Ability to follow all Sound Physicians policies regarding security and confidentiality.
• Adheres to all company policies and procedures.
• Represents Sound Physicians confidentially and professionally at all times.
• Develops productive working relationships with all levels of management and Compliance Program staff.
• Immediately reports regulatory compliance issues or concerns to the Compliance Director.
• Maintains strict confidentiality of all information obtained from any source in accordance with privacy and disclosure laws and Sound Physicians policies.
• Consistently demonstrates integrity, initiative and team-building support. Role model for professionalism, highly organized approach and commitment to continuous improvement.
• Ability to evaluate current workflows and processes with a critical eye and develop proposals for improvement.
• Extensive knowledge of ICD-9-CM and ICD-10 CM, CPT and HCPCS coding principles and guidelines.
• Knowledge of federal and state regulations related to documentation, coding and billing.
• Successful experience working both independently and in teams.
• Demonstrated ability to establish positive and courteous working relationships, effectively manage competing priorities, apply critical thinking skills, and accurately complete highly detailed work.
• Ability to work within a complex environment and leverage resources to meet the needs of clients, customers and coworkers.
• Demonstrated ability to communicate effectively orally and in writing with all levels of management and medical staff.
• Effectively contribute to projects in a shared leadership model.
• Ability to interpret physicians’ documentation and identify/extract billable services from medical records.
• Ability to understand and analyze system connections and impacts, both internal and external, for a large healthcare organization.
• Ability to utilize root-cause analysis to make process improvement decisions and implement change.
• Consistent exercise of discretion and judgment.
• Documented initiative to further one’s coding skills via coding-related continuing education, professional association participation, or other similar activities.
• Excellent oral and interpersonal communication skills, with the ability to convey a positive and professional image in person, and to interact effectively with diverse personalities and backgrounds.
• Knowledge of CMS and ACGME teaching physician documentation standards.
• Knowledge of media production, communication, and dissemination techniques and methods. This includes alternative ways to inform and entertain via written, oral, and visual media.
• Must be highly organized, detail oriented, and able to manage multiple competing priorities with a high degree of speed and accuracy.
• Proficiency with Windows based software and Microsoft Office Suite products in a network environment.
• The ability to absorb information and form general rules or conclusions (including find relationships among seemingly unrelated events); and to apply general rules to specific problems to produce answers that make sense.
• Use logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
• Use relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards.
• Bachelor’s degree in a health sciences discipline, business or related field desired.
• A current coding credential from AHIMA and/or AAPC.
• Minimum of two years experience with hospital billing and coding operations or compliance.
VII. SPECIAL JOB OR ENVIRONMENTAL CONDITIONS:
• Indoor office environment
• May require periodic travel to Sound Physicians’ locations
• Telecommuting is acceptable