What are the responsibilities and job description for the Compliance Reimbursement Consultant - Atrium Health Wake Forest Baptist FT Day REMOTE position at Aurora Health Care?
Major Responsibilities
- Contributes to the development (through risk assessment), execution, and updating of the Compliance & Integrity Department’s annual compliance work plan, with focus on reviews impacting health system reimbursement
- Conducts and/or leads Enterprise compliance reviews and investigations impacting hospital and physician reimbursement., Participates in other compliance activities including design and documentation of the review/investigatory methodology.
- Performs data collection for proactive reviews and investigations of potential compliance issues. Assists in other compliance activities such as risk assessments, surveys, etc. Participates in the use of analytical software and statistical sampling techniques to identify compliance concerns.
- Collaborates with various departments to obtain information needed in conducting risk-based reimbursement reviews, and investigations. Uses the collected information to scope the reviews and investigations, develop statistical sampling methodologies, and conduct the reviews.
- Prepares reports of reviews and investigations and delivers the results to Operational Leaders.
- Facilitates and/or assists in the design of corrective action in departments throughout the Enterprise to promote compliant practices and processes.
- Performs tracking and follow-up to ensure all identified corrective actions are complete.
- Preparing documentation and communication to report compliance repayments to governmental agencies and other payors.
- Assists in creating education and communication material for internal and external audiences on compliance issues.
- Partners with leadership to establish ongoing compliance monitoring and reporting. Performs follow-up activities to ensure corrective action plans have been implemented and maintained.
- Prepares routine reports for Operational leaders and Compliance Committees regarding the compliance review activities and actions taken and creates reports for regulatory agencies as directed.
- Reviews and opines on clinical services involving new services and/or external vendors.
- Performs research related to regulatory requirements involving health system reimbursement. Prepares regulatory guidance documents to share with other members of the Compliance & Integrity Department and Operational Leaders.
- Completes special compliance related projects as needed.
- CCS, CCS-P CPC, CHC or CRCR certification required
- Bachelors Degree or equivalent knowledge in Health Care Administration, Medical Coding, Health Information Management or health related field.
- Typically requires 5 years of experience in a health care environment with knowledge of health care regulatory requirements and medical coding and billing experience.
- Working knowledge of compliance related regulations such as coding, billing, documentation requirements, Local and National Coverage Determinations, National Comprehensive Coding Initiatives, Medicare/Medicaid billing regulations, HIPAA Privacy rule, etc.
- Strong computer, problem-solving and analytical skills, including ability to perform data mining to identify aberrant patterns that may be indicative of compliance issues or trends.
- Highly motivated, team oriented, professional, and trustworthy, with strong skills in personal diplomacy.
- Presentation and writing skills to prepare and organize media for delivery of reports and education to physicians, leadership, and teammates.
- Demonstrated ability to handle sensitive communications with leadership, physicians, management, and legal counsel.
- Strong organizational and time management skills.
- Proficiency in Microsoft Office Suite software. Demonstrated ability to prepare spreadsheets and presentation materials.
- This position may require travel, therefore, will be exposed to weather and road conditions.
- Operates all equipment necessary to perform the job.
- Exposed to a normal office environment.
Salary : $41 - $62