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Compliance Educator - Healthcare Job in Ann Arbor, Michigan

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Job Title: Compliance Educator - Healthcare

Employer:IHA
Type:Full-Time
Skills:CPC,Coding,Reimbursement,Insurance,Auditing
Required Certifications:CPC
Required Experience:1 to 2 years
Location:Ann Arbor, MI
Date Posted:8/19/2019

- Bachelor's Degree
- Cert Professional Coder (CPC)

POSITION DESCRIPTION:

The Compliance Auditor/Educator is a point of contact for IHA offices for proper coding procedures and workflow for existing medical services; provides support for the development and maintenance of IHA coding and billing standards and IHA fees.   Educates providers and staff on correct principles, procedures, and standards.  Performs compliance and medical record audits.

 

 

ESSENTIAL JOB FUNCTIONS:

1.      Under the direction of the Coding and Compliance Manager, performs compliance and medical record audits; Measures compliance with IHA policies, procedures, workflow and insurance company requirements.

2.      Assists in the planning, organizing, and completion of auditing activities required to comply with federal payers and other compliance-related requirements.

3.      Identifies errors in coding and documentation, lost revenue opportunities and any overpayments made due to errors in coding, insufficient medical record documentation, and reports findings.

4.      Educates Providers on correct coding principles and works with Providers to increase and strengthen health care providers' awareness and understanding of medical record documentation guidelines and coding principles.

5.      Provides training for IHA staff and physicians on CPT and ICD 10 coding standards and procedures.

6.      Serves as a role model for ethical management behavior and promotes awareness and understanding of IHA's Standards of Care and Compliance Plan.

7.      Assesses risk and develops an audit and education plan to support the overall compliance plan.

8.      Researches and provides written processes and guidelines for correct coding.

9.      Responds to events requests, reviews the problem and recommends solutions.  Monitors the event to resolution and promotes prevention steps.    

10.   Works closely with IHA's Compliance Team to maintain coding standards and procedures in alignment with regulatory and payer requirements.

11.   Ability to analyze RBRVU data in correlation to IHA's fee schedule; ability to effectively navigate through NextGen and other relevant practice management systems specifically with respect to understanding billing and office procedures.

12.   Drives to offices and other training sites to educate staff and/or providers.

13.   Performs other duties as assigned.

 

 

ORGANIZATIONAL EXPECTATIONS:

1.      Creates a positive, professional, service-oriented work environment by supporting the IHA CARES mission and core values statement.

2.      Must be able to work effectively as a member of the Compliance team.

3.      Successfully completes IHA's "The Customer" training and adheres to IHA's standard of promptly providing a high level of service and respect to internal or external customers.

4.      Maintains knowledge of and complies with IHA standards, policies and procedures, including IHA's Employee Handbook.

5.      Maintains general knowledge of IHA office services and in the use of all relevant office equipment, computer, and manual systems.

6.      Serves as a role model, by demonstrating exceptional ability and willingness to take on new and additional responsibilities.  Embraces new ideas and respect cultural differences.

7.      Uses resources efficiently.

 

 

MEASURED BY:

Performance that meets or exceeds IHA CARES Values expectation as outlined in IHA Performance Review document, relative to position.

 

 

ESSENTIAL QUALIFICATIONS:

EDUCATION:  Bachelor's Degree or equivalent combination of education and experience.

CREDENTIALS/LICENSURE: Certified Professional Coder designation is required; Certified Auditor or HIM designation is preferred.

MINIMUM EXPERIENCE:  2 years of experience coding, reimbursement analysis, insurance issue resolution and medical record auditing.  Previous experience with primary care and multi-specialty care preferred, other relevant experience would include provider relations or customer service representative work with a health care insurance organization. Claims payment and data management experience is highly desirable.

 

 

POSITION REQUIREMENTS (ABILITIES & SKILLS):

1.      Demonstrated understanding and/or hands-on experience with office processes, procedures and workflows.

2.      Substantial knowledge of managed care and insurance practices, insurance claims and billing process, fee schedules and pricing.  Ability to research billing guidelines effectively to provide direction on compliance coding. 

3.      Maintains working knowledge of federal, state, and insurance company regulations and contract requirements affecting compliance in a healthcare setting; compliance plan and auditing standards.

4.      Proficiency in multi-tasking and meeting sensitive deadlines in a fast-paced environment with a personal commitment to producing the highest quality work and providing extraordinary customer service; demonstrated ability to effectively follow through on assigned projects.

5.      Proficient in operating a standard desktop and Windows-based computer system, including but not limited to, Microsoft Word and Excel, PowerPoint, intranet and computer navigation.  Ability to use other software as required while performing the essential functions of the job including EPM and EHR systems.

6.      Excellent communication skills in both written and verbal forms, including proper phone etiquette.  Ability to present effective group educational sessions to providers. 

7.      Ability to work collaboratively in a team-oriented environment; courteous, professional and friendly demeanor.

8.      Ability to work effectively with various levels of organizational members.

9.      Good organizational and time management skills to effectively juggle multiple priorities and time constraints in a fast-paced environment.

10.   Ability to exercise sound judgment and problem-solving skills.

11.   Ability to maintain any organizational information in a confidential manner.

12.   Successful completion of IHA competency-based program within introductory and training period.

13.   Ability to drive to offices and other training sites to educate staff and/or providers.

14.   Ability to work overtime hours as scheduled.


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