PHYSICIAN COMPLIANCE ANALYST SENIOR
Company: UNC Health Care
Location: Morrisville
Posted on: October 10, 2024
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Job Description:
DescriptionBecome 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: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.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.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.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.Special Projects - Performs special projects as
requested by management as needed or assigned.Supervision - May
supervise compliance staff.Other InformationEducation
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 DetailsLegal Employer: NCHEALTHEntity:
Shared ServicesOrganization Unit: Physician ComplianceWork Type:
Full TimeStandard Hours Per Week: 40.00Salary Range: $29.98 -
$43.10 per hour (Hiring Range)Pay offers are determined by
experience and internal equityWork Assignment Type: HybridWork
Schedule: Day JobLocation of Job: US:NC:MorrisvilleExempt From
Overtime: Exempt: YesThis 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
applicant.accommodations@unchealth.unc.edu if you need a reasonable
accommodation to search and/or to apply for a career
opportunity.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.
Keywords: UNC Health Care, Durham , PHYSICIAN COMPLIANCE ANALYST SENIOR, Professions , Morrisville, North Carolina
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