Physician Compliance Analyst Senior

Job Description

Description

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:
Responsible for assisting Compliance management in all compliance activities which could include reviewing internal processes, documents and reports, and ensuring compliance with internal and external regulatory framework. Serves as an expert resource to physicians, coders and reimbursement analysts across UNC Health Care. May supervise compliance staff.

Responsibilities:

1. Auditing and Monitoring - Stays current with changing regulations, policies, procedures, standards and coding guidelines. The individual effectively identifies and analyzes areas of weakness, research causes and formulate recommendations that enhance operations and compliance. Familiarizes self with area under review, and if necessary, visits department/facility to gain operational and process knowledge. Researches all relevant materials including but not limited to regulations, policies, procedures, and other standards such as CPT coding guidelines and CMS policies. Assists in preparing annual audit and work plan. Performs work outlined in work plan. Obtains and analyzes data. Identifies and evaluates the area under review, identifying and documenting areas of risk and vulnerability related to non-compliance. Assists in development of new policies and procedures and audit tools. Performs E/M and Procedural coding audits. Analyzes audit findings and reports/tracks results for one-on-one or group feedback. Performs billing audits and ensures correct coding and billing compliance. Documents audit work and findings in accordance with department standards. During the audit and monitoring process, identifies and analyzes areas weaknesses, research causes, and formulate recommendations back to the appropriate department. Provides communication of audit findings to department leadership as directed by management. Seeks out and analyzes opportunities to improve and enhance professional compliance in areas such as coding, clinical documentation, charge capture, and EPIC. The auditor should be familiar with clinical documentation and charge capture methodologies.
2. Customer Service - Provides courtesy and friendly service. Develops productive working relationships with all levels of management, staff and providers. Identifies and seeks resolution to barriers. Participates in committee work, workshops and cross functional teams as directed. Viewed as a facilitator or negotiator that can assist in areas of disagreement. Conducts and/or facilitates meetings where information is shared with operational departments concerning new regulations, billing requirements and other compliance activities or other standards. Provides one-on-one and/or group meetings with providers regarding coding/compliance education. Assists with the development and delivery of appropriate compliance training and education across the UNC Health Care System. Serves as an expert resource to physicians, coders and reimbursement analysts. Responds to inquiries on how best to code, document and bill for services provided.
3. Investigations - Familiarizes self with area under review. Researches and gathers all relevant materials including but not limited to regulations, policies, and procedures, coding guidelines, and CMS rules regulations. Conducts interviews understanding operational workflows in order to thoroughly assess compliance issues and risk. Performs data collection and analysis. Documents findings in accordance with department standards, communicates findings as directed by management and provides an analysis of findings with recommendations. Works with departmental leaders on corrective action plans.
4. Professional Development - Maintains current knowledge of CPT and ICD coding guidelines as well as CMS policy and regulations. Reads trade journals articles related to coding and compliance and shares knowledge with peers and customers.
5. Special Projects - Performs special projects as requested by management as needed or assigned.
6. Supervision - May supervise compliance staff.

Other Information

Education Requirements:
• Bachelor's degree in Accounting, Business Administration, Health Administration, Nursing or related field (or equivalent combination of education, training and experience).
Licensure/Certification Requirements:
• Coding certification (e.g., CPC, CCS-P)
Professional Experience Requirements:
• If a Bachelor's degree: Three (3) years of experience in business, health care, coding, revenue cycle, legal, regulatory compliance, or a supervisory role in Revenue Cycle or HIM.
• If an Associate's degree: Seven (7) years of experience in business, health care, coding, revenue cycle, legal, regulatory compliance, or a supervisory role in Revenue Cycle or HIM.
• If a High School diploma or GED: Eleven (11) years of experience in business, health care, coding, revenue cycle, legal, regulatory compliance, or a supervisory role in Revenue Cycle or HIM.
Knowledge/Skills/and Abilities Requirements:
• Advanced and demonstrated ability to research regulations and understand professional billing and reimbursement methodologies. -Must be familiar with reference sources and have the ability to navigate and link various sources of regulations and standards. Interpret billing compliance and other regulations and apply them to specific situations or scenarios.-Advanced understanding of clinical and revenue cycle operations. Demonstrates an understanding of the operating environment and how these operations and the demands of productivity interface with regulatory requirements. -Advanced knowledge of the Professional Compliance Program requirements. Must be able to understand, demonstrate, and teach professional compliance, billing and coding compliance to others. Ability to gather evidnce, analyze data and develop recommendations. -Advanced data analysis and critical thinking skills required. -Advanced Microsoft Application Proficiency with the ability to use graphs, pivot tables, and formulas. Ability to create Visio flow charts.
• Must have advanced presentation skills. Must be able to educate physicians, mid-level providers, support staff and administration on medical record documentation requirements as set forth by the Federal Documentation Guidelines as well as other compliance education areas and audit findings. -Must have the ability to transfer technical coding and billing information and knowledge to non-technical users. -Advanced organizational skills with the ability to manage multiple projects and multiple deadlinesource to physicians and others, provides exceptional customer service.-Ability to work with well others and conduct work in respectful manner. Follows normal business protocol. Demonstrates a positive attitude. Maintains appropriate professional conduct, appearance and language. Is tactful and respectful in communication.
• Advanced ability to advise management and departmental stakeholders on compliance issues and risk. -Must have advanced ability to listen carefully and follow directions. The Auditor should ask for clarification and seek guidance when needed. -Possesses advanced knowledge of CPT, ICD 9 and ICD 10 coding. Interprets both inpatient and outpatient services for medical specialties using substantial knowledge of anatomy, physiology, medical terminology and reimbursement methodologies.-Serves as a support resRequires excellent verbal and written communication skills. Must be able to clearly express thoughts and ideas and must possess the ability to effectively transfer knowledge to others. Must be able to interview staff to understand operational processes and areas of concern. Written communications must be clear, concise and professional. -

Job Details

Legal Employer: NCHEALTH

Entity: Shared Services

Organization Unit: Physician Compliance

Work Type: Full Time

Standard Hours Per Week: 40.00

Salary Range: $29.98 - $43.10 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type: Hybrid

Work Schedule: Day Job

Location of Job: US:NC:Morrisville

Exempt From Overtime: Exempt: Yes

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job.

Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email [email protected] if you need a reasonable accommodation to search and/or to apply for a career opportunity.