Compliance Coordinator

Position Responsibilities

• Reviews a wide variety of coding policies and procedures to ensure compliance with legal, accreditation, and internal standards.
• Analyzes existing policies, identifies gaps, and recommends new/revised standards and monitoring methods for departmental use.
• Reviews detailed departmental processes and policies noting deficiencies.
• Researches and develops materials for educational programs related to all aspects of coding and documentation.
• Designs and implements risk assessments to analyze processes for coding and documentation to identify areas for improvement.
• Prioritizes risk assessments based on level of the organizational exposure.
• Investigates and responds to audit and denial findings in collaboration with stakeholders.
• Audits potential issues before they are identified by the regulatory auditors.
• Collaborates with PCD managers regarding coding changes and other audits.
• Coordinates with clinic leadership, providers, compliance, and/or leadership for presentations of assessment results.
• Verifies compliance/noncompliance issues against established policies, procedures, applicable laws, and regulations.
• Facilitates the resolution of noncompliant findings and escalates possible critical issues to QA Manager.
• Audits may focus on, but are not limited to, documentation, billing, coding, medical necessity, systems, and reimbursement.
• Analyzes results of assessments for presentation to clinic leadership, providers, compliance, and/or leadership.

Required Qualifications

• Bachelor’s degree or an equivalent amount of education and experience is required.
• CPC, CCS, COC, RHIT, or RHIA certification is required.
• 3 years of relevant health care coding/billing experience.
• Knowledge of insurance regulations and Medicare and Medicaid guidelines as related to clinical documentation and clinical indicators.
• Strong problem-solving and research skills.
• Ability to interpret CMS regulations and guidance.
• Demonstrated ability to provide coding advice to all areas of coding staff, other departments throughout UI Health Care, and other entities as requested.
• Demonstrated ability to analyze complex clinical scenarios and apply critical thinking.
• Ability to plan and organize education programs, as well as teach effectively and write education guides and handouts.
• Experience with EPIC or other electronic medical records system.
• Excellent written, verbal, and interpersonal communication skills.
• Proficiency with MS Word, PowerPoint, and Excel, including database and spreadsheet analysis.

Desired Qualifications

• Experience performing coding audits.
• Knowledge of UI Health Care policies and procedures.