University of Mississippi Medical Center
Introduction:
To plan, direct, and manage hospital compliance activities to ensure regulatory compliance in such areas as documentation, coding, billing rules/policies/regulations as required by Federal/State payers and other third-party payers. Responsible for managing workflows and monitoring effectiveness of staff.
Must be familiar with federal compliance statues. Must have current and extensive knowledge of CPT and ICD coding principles and guidelines, Medicare/Medicaid Regulations, Insurance Plans and Medical Terminology. Strong verbal, written and presentation skills. Ability to gather and analyze medical records and billing data to generate reports.
Job Description:
- Manages the strategic focus of the hospital compliance unit that performs audits on hospital coding, billing, etc. Directly involved in staff decision-making, setting goals to be accomplished, and overseeing the overall achievement of those goals.
- Works closely with the Director and assists in the development of the Risk Assessment Plan approved by the Health Care Compliance Management Committee. Responsible for the audits regarding the hospital risk areas delineated on the Risk Assessment Plan.
- Maintains audit statistics and reports for presentation.
- Identifies and assists in correcting aberrant trends with hospital coding and billing.
- Assists with the resolution of compliance issues and responds to information requests from personnel.
- Ensures continued compliance with state and federal requirements with knowledge of existing and new legislation and recommends new policies and procedures when necessary.
- Assists and/or conducts education and compliance training of personnel.
- The duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time.
Education Qualifications:
Bachelor’s degree plus three years of related experience in a healthcare setting. Certification from American Health Information Management Association (AHIMA), American Academy of Professional Coders (AAPC), and/or Health Care Compliance Association (HCCA) preferred.