The Senior Coding Compliance Consultant is responsible for performing a variety of activities in support of compliance program initiatives, with a focus on inpatient, outpatient and/or professional services coding.
- Must have a Bachelor's degree in Health Information Management, a clinical field, healthcare administration, business administration or related field.
- Must have six (6) years of progressively responsible experience in a healthcare related administrative, financial, or compliance role with a minimum (2) two years' experience conducting compliance-related reviews and audits involving federal healthcare programs, including Medicare and Medicaid.
- Must possess mastery-level expertise in documentation requirements, coding and billing requirements and federal and state regulatory requirements for inpatient, outpatient and/or professional services coding.
Equivalent Education and/or Experience
- May have an equivalent combination of education and experience in lieu of specific education and/or experience as stated above.
- Certification in a healthcare compliance-related specialty is required
- Must be currently certified and in good standing with one of the following: Certified Coding Specialist (CCS) - Certified Coding Specialist-Physician based (CCS-P) - Certified Professional Coder (CPC) - Certified Professional Coder Hospital Outpatient (CPC-H)
- Prefer Registered Health Information Administrator (RHIA) - Registered Health Information Technician (RHIT) - Certified Inpatient Coder (CIC)
Skills or Special Abilities
- Must have excellent verbal and written communication skills.
- Must be able to communicate effectively with all levels of personnel and demonstrate tact and diplomacy skills.
- Must have strong organizational and planning skills.
- Must demonstrate a high degree of personal integrity and practice ethical standards.
- Must demonstrate strong leadership skills.
- Must be computer literate and proficient with Microsoft Office, electronic medical records and coding, billing and claims payment applications.
1. Conducts reviews to determine whether claims reflect the appropriate ICD-10-CM and CPT/HCPCS codes. Consults with management to report findings and provide corrective action recommendations.
2. Conducts thorough research and provides prompt, courteous consultative services regarding coding compliance matters.
3. Assists in monitoring and responding to audits and/or inquiries from government agencies and contractors.
4. Assists with the development of new, or revisions of, existing policies and procedures, as warranted, based upon regulatory developments and compliance monitoring and auditing activities/findings.
5. Stays abreast of the latest developments, advancements, and trends in coding compliance. Monitors changes in laws and regulations related to coding compliance and communicates changes to appropriate personnel.
6. Collaborates with personnel across Parkland particularly in the Internal Audit, Patient Financial Services, Health Information Management, Care Management, Government Reimbursement, Regulatory and Accreditation, Clinical Research, Clinical Support Services, and Legal Department, and with representatives of UTSW.
7. Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland.
8. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the Coding Compliance. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.
1. Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland.
2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
3. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.
Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.
Nearest Major Market: Dallas
Nearest Secondary Market: Fort Worth
Job Segment: Medical, Patient Care, Medical Coding, Medicare, Medicaid, Healthcare