Billing Compliance Nurse Specialist - Billing Compliance, USA Health Shared Services, University Hospital

Overview

USA Health is Transforming Medicine along the Gulf Coast to care for the unique needs of our community. USA Health is changing how medical care, education, and research impact the health of people who live in Mobile and the surrounding area. Our team of doctors, advanced care providers, nurses, therapists, and researchers provides the region's most advanced medicine at multiple facilities, campuses, clinics, and classrooms. We offer patients convenient access to innovative treatments and advancements that improve the health and overall well-being of our community.

Responsibilities

• Work is performed under the general supervision of administrative leadership and is evaluated through audit outcomes, reporting accuracy, regulatory compliance and achievement of departmental goals.
• The Billing Compliance Nurse Specialist is responsible for performing professional compliance reviews for USA Health. This position evaluates medical record documentation, coding accuracy, charge capture, billing practices and payor compliance to ensure adherence with federal, state and payor guidelines, as well as organizational policies.
• Provides coding, documentation and compliance education to: Physicians, Advanced Practice Providers, Clinical staff, Coding staff and Revenue Cycle personnel as needed.
• Audits compliance with NCCI edits, LCDs, NCDs, CMS and payor specific billing requirements.
• Analyzes audit findings and prepares detailed reports, summaries, and recommendations to administration, department leadership, physicians, and operational teams.
• Collaborates with HIM, Patient Financial Services, Revenue Integrity, Compliance and Operational Departments to resolve billing and documentation issues.
• Maintains current knowledge of: CMS regulations, Alabama Medicaid and Commercial Payor requirements, coding updates and industry best practices where applicable.
• Travels to hospital departments, clinics and affiliated locations as necessary to perform audits, education and compliance reviews.
• Attends seminars, educational programs, and professional development activiteis as required.
• Maintains confidentiality and protects sensitive patient and organizational information in accordance with HIPAA and organizational policies.
• Completes all mandatory department, educational and hospital requirements
• Adheres to current Infection Control and Safety Standards
• Regular and prompt attendance
• Ability to work schedule as defined and overtime as required
• Related duties as assigned
  
  
  

Additional Information

Employees must be in a regular position, working 20 hours or more per week (.50 FTE or greater) to qualify for benefits.

Qualifications

• Graduation from an accredited school of nursing meeting the minimum standards set by the state of Alabama and 1 year of professional nursing experience Required
• Experience in medical coding, auditing, and training Preferred
• Certified Coder-AHIMA or AAPC within 1 Year Required
• RN - Registered Nurse - State Licensure and/or Compact State Licensure in accordance with the Nurse Licensure Compact (NLC) for Alabama Required
• Comparable combination of education and experience may substitute for the above requirements.
  
  
  

Equal Employment Opportunity/Affirmative Action Employer

The University of South Alabama is an Equal Opportunity Employer and does not discriminate on the basis of race, color, national origin, sex, pregnancy, sexual orientation, gender identity, gender expression, religion, age, genetic information, disability, protected veteran status or any other applicable legally protected basis. EO Employer – minorities/females/veterans/disabilities/sexual orientation/gender identity.