Summary

Leads and conducts activities related to the development, communication, oversight, and monitoring of healthcare compliance programs within the College. The ideal candidate will have direct healthcare compliance experience gained in a healthcare or educational institution, including experience with clinical processes, revenue cycle, research, grants and contracts, and education processes.

Job Duties

• Leads and conducts activities related to the development, communication, oversight, and monitoring of healthcare compliance programs within the College.
• Communicates with contacts both within and outside of function on matters that require explanation, interpretation, and/or advising. May require communication with senior leadership. 
• Influences parties within the department regarding concepts, practices and approaches. 
• Coaches, reviews and delegates work to lower-level professionals.
• Manages moderately complex projects or processes. May manage large projects or processes that span outside of the department. 
• Works to achieve operational, functional, and/or business targets with significant impact on departmental results.
• Recognized subject matter expert; helps develop new and improved products, processes and systems within the department.
• Contributes to the development of goals and planning efforts for the department. 
• Identifies billing and coding inconsistencies and coordinates with professional team to communicate the findings and provide the most current guidelines.
• Understands, interprets and applies coding guidelines for coding audits.
• Audits inpatient and outpatient encounters code assignments; generates and distributes reports of clear and accurate audit findings at both practice and provider level; outlines findings and recommendations for improvement of documentation. 
• Researches and evaluates coding, documentation practices, and processes, and identify billing policy and coding trends through data analysis or chart review.
• Reviews medical records to determine coding accuracy of all documented diagnoses and procedures. 
• Reviews claims to validate submitted codes and abstracted data, and discharge disposition which all impact facility reimbursement. 
• Provides individual and group education/presentations to coding staff, physicians, and others throughout the organization that require coding knowledge; monitors and reports progress to ensure compliance with coding standards and expectations.
• Monitors work quality and team productivity to ensure adherence to department standards. 
• Develops and trains other team members.
• Performs other job-related duties as assigned.

Minimum Qualifications

• Bachelor's degree.
• Six years of relevant experience.

Preferred Qualifications and Skills

• In-depth knowledge of federal and state healthcare regulations (e.g., HIPAA, HITECH, ACA) and relevant standards (e.g., CMS).
• Proficiency in data analysis and relevant compliance management software.
• Strong analytical, critical thinking, and problem-solving skills. 
• Excellent written and verbal communication, negotiation, and interpersonal skills. 
• Requires mastery of specialty area and working knowledge of industry practices/other areas, typically obtained through advanced education and strong experience.