Overview

The purpose of this position is to oversee the operations of the Revenue Cycle Billing and Reimbursement Compliance function across the OBHS enterprise and to ensure that the organization is in compliance with federal, state, and company guidelines. This position is also responsible for conducting audits of medical record documentation billed to third party payers. The audits will determine whether billed services provided to patients are consistent with medical record documentation and in accordance with the appropriate third party billing regulations and standards. The position reports to the OBHS Chief Compliance Officer.

Responsibilities

• Maintains a thorough understanding of CPT, ICD-10-CM, and HCPCS coding principles, governmental regulations and third party guidelines regarding documentation and/or billing compliance.
• Conduct audits and prepare and maintain audit work papers and audit reports; prepare recommendations for improvement and communicate compliance audit findings and recommendations to department management’s development of corrective action plans.
• Act as a resource for Compliance staff and other departments for designing and providing specialized training.
• Perform specialized case assignments, documentation reviews, and reviews of policy and documentation guidelines.
• Proactively develop and maintain a close working relationship with the Coding, Billing and Reimbursement staff to assure that documentation issues, pattern and/or trends are identified, prevented and addressed by corrective action and compliance education in a timely manner.
• Track corrective action plans for completion and conduct follow-up with management as needed to foster successful completion and achieve compliance.
• Develop periodic revenue cycle compliance reports of auditing and monitoring activities, findings, risk levels, recommendations, status or corrective action plans, and outcomes.
• Collaborate with appropriate personnel for the development, review, and implementation of compliance-related policies, procedures, education, or workflows relating to clinical, billing, coding or other business activities pertinent to the Compliance Program.
• Assist in the drafting of self-reporting disclosure letters to government agencies or payers.
• Create monthly refund reports for Billing Compliance to ensure inadequate payments received are refunded to the appropriate carriers.
• Remain current with new rules, regulations, and revisions, as set forth by CMS and other entities regarding Billing Compliance. Develop training and education sessions for Billing Compliance.
• Perform other duties as assigned.

Qualifications

Education:• Bachelor’s Degree in in Healthcare Finance/Business or a related field.

Experience:• 4 years of experience in regulatory and/or compliance in a healthcare setting is required in understanding and implementing government regulations.

Certification:• CHC Certification or other Coding Certification, (e.g., CCS, CPC, etc.)

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions without compromising patient care.

The statements herein are intended to describe the general nature and level of work being performed by employees, and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified. Furthermore, they do not establish a contract for employment and are subject to change at the discretion of One Brooklyn Health System (OBHS), and Interfaith Medical Center (IMC).

One Brooklyn Health System (OBHS), and Interfaith Medical Center are an equal opportunity employer, it is our policy to provide equal opportunity to all employees and applicants for employment without regard to race, color, religion, national origin, marital status, military status, age, gender, sexual orientation, disability or handicap or othercharacteristics protected by applicable federal, state, or local laws.