Compliance Specialist

Columbus, OH, United States

Overview:

Looking to join and lead a dynamic team at Ohio State University Physicians where excellence meets compassion!?

Who we are

With over 100 cutting-edge outpatient center locations, dedicated to providing exceptional patient care while fostering a collaborative work environment, our buckeye team includes more than 1,800 nurses, medical assistants, physicians, advanced practice providers, administrative support staff, IT specialists, financial specialists and leaders that all play an important part. As an employee of Ohio State University Physicians (OSUP), you'll be an integral part of a team committed to advancing healthcare, education, and professional growth.

Our culture

At OSUP, we foster a culture grounded in the values of inclusion, empathy, sincerity, and determination. We meet our teams where they are, coming together to serve each other and our community.

Our benefits

We know that having options and robust benefit plans are important to you. OSUP prioritizes the wellbeing of our team and thats why we offer our employees a flexible, competitive benefit package. In addition to medical, dental, vision, health reimbursement accounts, flexible spending accounts, and retirement, we also offer an employee assistance program, paid time off, holidays, and a wellness program designed to support our employees so they can live their best lives.

Responsibilities:

Purpose: To conduct quality assurance reviews of physician coding and documentation, to verify and ensure the accuracy, completeness, specificity and appropriateness of diagnosis codes based on services rendered; and to provide education to staff and physicians regarding coding.

Conduct reviews of patient charts and medical record documentation for group faculty to determine accurate CPT, HCPCS procedure, professional supply codes and ICD-9-CM diagnosis codes, including by not limited to those mapped to an HCC at the encounter level.

Collaborate with providers, peers and Compliance leadership to obtain additional information and provide further education on coding guidelines. Discuss audit results and provide recommendations where warranted.

Keep current with medical compliance and reimbursement policies, such as medical necessity issues and correct coding issues. Maintains knowledge of CMS, state and federal coding rules and regulations. Effectively communicating updates.

Revised 5.2023

Develop and deploy tools, documentation, education materials and courses for providers and staff. Provide training and education on coding, documentation and other compliance issues to physicians, non-physician providers, and staff on an ongoing basis.

Provide orientation training and education on coding, documentation, PATH and other compliance issues internally in Compliance and externally with physicians and staff.

Conduct research on various compliance and documentation issues.

Respond to and track third party inquiries regarding level of service coding by the physicians.

Distribute the OSUP Compliance Program to all persons and entities identified as involved in documenting, coding and billing for services within the designated group.

Review explanations of benefits (EOBs) from payers, evaluating denied claims and filing appeals for denied claims.

Serve as a liaison between coding and billing personnel and physicians.

Preparing weekly reports of audit and education activities.

Responsible for meeting daily production and quality goals on a consistent basis.

Travel may be required to facilitate training.

Attendance, promptness, professionalism, the ability to pay attention to detail, cooperativeness with co-workers and supervisors, and

politeness to customers, vendors, and patients.

Other duties and special projects as assigned.

Qualifications:

Requirements:

Certification as a CPC, CCS-P, RHIT or RHIA required or may hire on the condition of obtaining certification within first two (2) years of employment.

Minimum of two years experience with coding and reimbursement for physician services.

Skills in exercising initiative, judgment, discretion and decisionmaking to achieve organizational objectives.

Skills in establishing and maintaining effective working relationships with physicians and other mid-level providers. Strong writing and presentation skills, solid interpersonal communication and facilitation skills are essential.

Must have knowledge of physician auditing practices and an in-depth knowledge of CPT, ICD-9-CM diagnosis codes and HCPCS procedure and professional supply codes used for billing services provided by physicians and non-physician providers.

Knowledge of third party fee profiles and reimbursement requirements is preferred.

Must have knowledge of a variety of computer software applications in word processing, spreadsheets, database and presentation software (MSWord, Excel, Access, PowerPoint).

A wide degree of creativity and latitude is expected. Work effectively with individuals and teams, able to contribute to and influence management.

Must be able to interact and communicate with individuals at all levels of the organization.

Analytical ability to gather and interpret data and develop, recommends, and implement solutions.

Ongoing: Maintains current licenses and certifications.

Preferred: Associate or Bachelor degree in business or health related field as well as certified risk coder (CRC) certification. Prior experience with various systems such as EPIC, EncoderPro, or MD Audit; experience in academic medicine; and experience with data visualization tools such as Qlik.

Pay Range:

USD $57,414.13 - USD $86,121.20 /Yr.