Sr. Compliance Coordinator- Billing & Coding

About the position The Senior Compliance Coordinator conducts and coordinates reviews of BJCMG specialty provider documentation to ensure accuracy of services billed. This position prepares reports of findings to be presented to providers. This position also develops educational opportunities for new and existing providers giving instruction on federal and state regulations, documentation guidelines, and coding training in a way that ensures compliance with governmental regulations. Additionally, the Senior Compliance Coordinator collaborates with departments in providing appropriate education to staff as it relates to compliance and privacy of protected health information.

Responsibilities

• Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services identified as part of the review for specialty providers or upon request from management.
• Interacts with specialty providers regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation based on the review.
• Develops and/or presents educational training material to specialty providers and coders based on findings and trends identified as a result of the reviews; provides general education on coding and documentation rules and regulations, regulatory provisions, and third party payer requirements to new employees and providers to include Employee and Provider New Employee Orientation.
• Interacts with government agencies/contractors, management, employees and others, as necessary, to ensure an understanding of the organization’s compliance initiatives.
• Conducts and coordinates routinely scheduled reviews of BJCMG specialty providers' documentation involved with professional fee billing for accuracy of coding and physical presence; reviews consist of ambulatory E&M services and office procedures, as well as hospital admissions, subsequent visits, hospital procedures, and all other services performed by BJCMG specialty providers; reviews medical record documentation to identify under-coded and up-coded services, prepares reports of findings, and meets with providers to provide education and training on accurate coding practices and compliance issues; serves as subject matter expert related to specialty coding.
• Conducts focused reviews across the BJCMG enterprise based upon the Compliance Department's annual work plan and/or trends identified based upon internal reviews or requests from senior leadership; performs special projects as requested/assigned by management; monitors trends across the organization and develops education and training on accurate coding practices and compliance issues.
• Provides guidance and serves as mentor to fellow coordinators related to the audit process, coding, billing and compliance; identifies and notifies management educational opportunities and/or concerns as a result of serving as lead auditor.
• Support the HIPAA liaison by tracking and conducting employee investigations when requested.

Requirements

• High School Diploma or GED
• 5-10 years of experience
• CCS/CPC certification

Nice-to-haves

• Associate's Degree in Business/Healthcare Administration or related field
• RHIA/RHIT certification

Benefits

• Comprehensive medical, dental, vision, life insurance, and legal services available first day of the month after hire date
• Disability insurance paid for by BJC
• Pension Plan/403(b) Plan funded by BJC
• 401(k) plan with BJC match
• Tuition Assistance available on first day
• BJC Institute for Learning and Development
• Health Care and Dependent Care Flexible Spending Accounts
• Paid Time Off benefit combines vacation, sick days, holidays and personal time
• Adoption assistance

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