USC’s Office of Compliance promotes the university’s mission and
strategic plan by helping USC faculty and staff
employees understand and comply with applicable laws, rules, and regulations.
The Office of Compliance at USC is a
resource for navigating university rules, regulations and ethical expectations.
The Hospital Compliance department is seeking a Documentation and Coding
Specialist to be a part of a
growing team. The Documentation and Coding Specialist will be responsible for
investigating and responding to matters regarding complex coding,
documentation, compliance and/or reimbursement; developing, planning and
conducting comprehensive coding and/or documentation training for physicians
and other staff; assisting with development and implementation of new related
policies and procedures; functioning as quality assurance coordinator;
conducting quality control studies of coded data and documentation to ensure
compliance; participating in claims review process; overseeing design and
revision of divisional billing forms; overseeing billing dictionary updates
related to ICD-10 and CPT-4 codes; and
conducting inpatient and outpatient chart reviews. This individual will work
closely with medical group administrators, faculty and/or hospital
administrators, as appropriate.
- Investigates, responds
to and communicates information regarding complex coding, documentation, and/or
compliance matters. Analyzes coding and/or documentation issues/questions from
both a compliance and coding perspective. Performs research and provides
recommendations for use of codes and/or documentation in a timely manner. Works
closely with hospital administrators and faculty as appropriate, regarding
complex coding/documentation issues.
- Develops educational
materials, plans and conducts comprehensive coding and/or documentation
training for a highly regulated healthcare process based on training needs of
employees. Provides compliance/documentation educational
sessions for physicians and other staff. Provides coding and/or documentation
expertise for all compliance issues.
- Monitors and reviews
coding accuracy, documentation and/or clinical status determinations to support
professional fee coding.
- Functions as quality
assurance coordinator and technical support for coding/documentation and/or
clinical necessity applications, education and references. Measures and
maintains compliance standards for coding procedures. Conducts quality control
studies of coded data and billed services to ensure compliance.
- Assists with review,
development, modification and implementation of compliance policies and
procedures to achieve and maintain compatibility with billing requirements.
Advises and instructs physicians and other providers regarding billing and
documentation policies, procedures and regulations. Interacts with physicians
and other providers to obtain clarification of conflicting, ambiguous or
non-specific medical documentation.
- Participates in the
design and updates of billing forms and billing system dictionaries and/or
coding documentation queries to ensure that all ICD-10 and CPT-4 codes are up-to-date and/or documentation is
accurate and complete from both compliance and reimbursement perspectives.
- Performs chart reviews
for professional fees and/or outpatient and inpatient services billed through GECB and/or the hospital billing systems.
Analyzes results and prepare formal reports with findings and recommendations.
Facilitates and improves hospital staffs’ and/or physicians’ understanding of
payor and regulatory requirements by providing feedback related to
- Performs other related
duties as assigned or requested. The university reserves the right to add or
change duties at any time.
Associate's degree, Combined
experience/education as substitute for minimum education
Field of Expertise:
Associate degree in Health Information
Technology or related healthcare degree or Associate degree in Nursing or an
accredited Registered Nurse Program as evidenced by licensure or certification
in any of the following: RHT, RHIA, CCS, CPC-H, CPC, or CCS-P. Knowledge of
medical terminology or equivalent recent training or education. Knowledge of
auditing concepts and principles.
Basic knowledge of biology/anatomy/disease
processes, laboratory test and uses, prescription medications and their
respective guidelines. Experience working in a health setting reading and
understanding clinical and hospital health records. Candidates should satisfy
at least one set of the following:
1. Certification in any one of the following:
RHIT, RHIA, CCS, CPC-H, CPC, CCS-P. Intermediate comprehensive knowledge of ICD-10-CM, CPT and
HCPCS coding. Intermediate comprehensive and coding both facility and
professional services, utilizing ICD-10-CM, CPT and HCPCS.
2. Clinical experience as a RN or LVN in a case
management or case coordinator role with experience on patient status
determinations, Interqual and documentation.
3. Clinical background as a RN or LVN with
experience in medical auditing in an acute care setting.
4. Clinical experience as a RN or LVN with
expertise of case delivery documentation and related medical record documentation in an
Field of Expertise:
Three years of coding quality, documentation,
and provider or hospital compliance experience.
We pride ourselves on being a GREAT PLACE TO WORK, and that
begins with our employees! We offer a wide variety of benefits and programs
that support our staff and their families, including:
· Benefits: Health, dental,
and vision plans, tuition assistance for our employees and their families, paid
time off, flexible spending accounts, 2:1 retirement plan contributions, child
care centers, and up to $50,000 housing subsidy. And because we are a
qualifying public service organization, you may qualify for Public Service Loan
Forgiveness (PSLF) for educational loans. Please visit usc.edu for additional
· Perks: Discounts to USC sporting events, USC Bookstores,
wireless plans, travel, accommodations, and local entertainment.
· Career Growth: We
are the largest private employer in Los Angeles, offering tremendous
development opportunities in multiple fields and industries.