Entity/Organization: MUSC Physicians (MUSCP)
Hours per week: 40
Scheduled Work Hours/Shift: Monday - Friday 8:00am - 5:00pm
Pay Basis/FLSA: Salary / Exempt
Job Summary/Purpose: Manage compliance operations for assigned specialties, physicians and staff as established by the UMA Executive Compliance Committee. Provide physician/provider and staff education and serve as a resource to the assigned departments on coding, billing and regulatory issues.
Minimum Training and Education: Bachelors and 3 years’ experience or Associates Degree with 5 years’ experience required. Internal candidates may be considered without a degree based on coding certification and relevant experience. Experience educating physicians in group or individual training sessions. Demonstrates solid technical knowledge, understanding of business concepts, regulatory rules and auditing procedures. Experience researching coding questions and providing documentation to support coding decisions. Extensive knowledge of ICD-9/10, CPT, HCPS coding and Medical Terminology. Excellent communication and interpersonal skills. Must maintain credentials through education and stay current on regulatory trends and changes in the law. Knowledge of Microsoft Office Applications including Word, Excel and PowerPoint. Experience with and aptitude for using medical billing software.
Must be able to act independently in the furtherance of compliance objectives following Corporate Compliance Department established procedures and UMA policies. Must be able to identify and respond to escalated problems or questions in a timely fashion.
Required Licensure, Certifications, Registrations: CPC, CCS-P, RHIT or other Medical coding certification required.
Job Duties and Responsibilities:
- Attend all Departmental Compliance meetings, faculty meetings as directed by the Department Liaison or Administrator.
- Complete monthly audits following UMA Auditing Policy and report findings to the individual audited, the Physician Liaison, Department Administrator and Chairman on a monthly basis.
- Perform special audits as needed to ensure compliance, based on bell curve information, OIG Work Plan issues, New Providers, Level III Providers, helpline calls or other criteria established by the Director, Executive Compliance Committee or Department Administrator.
- Develop methodology for audits and reports in order to present findings in a clear concise manner. Responsible for follow up audits to validate resolution of documentation issues and completion of corrective action plans.
- Proactively instruct and supervise staff and physicians in proper coding guidelines, insurance carrier regulations, medical records and documentation requirements via departmental policies, memos and faculty meetings.
- Participate in departmental revenue cycle meetings to review operational information, procedures and policies to ensure accurate billing from process start to finish.
- Research Coding, HIPAA and other regulatory issues for faculty and staff in designated divisions, as well as for CRC and CBO contacts. Respond to concerns and allegations and work with Director or Sr. Manager to develop corrective action plans and follow up appropriate to the issues identified.
- Participate in the preparation and presentation of training and educational sessions for providers and billing staff. Responsible for preparing effective presentations.
- Responsible for entering all education sessions into Education Database in a time determined by the Sr. Compliance Manager
- Works closely with divisions and EMR technical staff in providing assistance and recommendations of EHR templates and other standardized documentation formats
- Assist Sr. Compliance Manager and Director of Compliance on special projects and other duties assigned
Physical Requirements: Continuous requirements are to perform job functions while standing, walking and sitting. Ability to bend at the waist, kneel, climb stairs, reach in all directions, fully use both hands and legs, possess good finger dexterity, perform repetitive motions with hands/wrists/elbows and shoulders, reach in all directions. Maintain 20/40 vision corrected, see and recognize objects close at hand and at a distance, work in a latex safe environment and work indoors. Frequently lift and/or carry objects weighing 20 lbs (+/-) unassisted. Lift from 36” to overhead 15 lbs. Infrequently work in dusty areas and confined/cramped spaces.