CORPORATE COMPLIANCE COORDINATOR - OLG CORPORATE COMPLIANCE - FT (JOB ID: 5345)
Location: 920 BUILDING
Employment Status: FT
The compliance program and its operations must meet or exceed the expectations of the Office of the Inspector General, the Department of Health and Human Services, and other federal and state regulatory enforcement agencies.The Corporate Compliance Coordinator, with oversight from the Director of Compliance, is responsible for keeping abreast of changes in laws and regulations that impact the system’s operations to insure compliance.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Provides audit support and corporate compliance assurance—includes issues specific to policy and procedure development and performance compliance with governing rules and policies.
Develops, maintains, and coordinates both LHVI and LGMC Audit plans in conjunction with the Director of Compliance to decrease compliance risks for the organizations.
Performs coding, billing, and medical record documentation audits as outlined by the audit plans and provides written reports outlining the findings of these audits.
Perform data analysis to ensure coding compliance, including level of service analysis against Medicare and other pertinent benchmarks as related to physician coding.
Develop and present educational materials, based on audit findings to providers, management, and billing staff regarding correct coding guidelines and governmental regulations.
Assist with the development and implementation of Corporate Compliance Policies and Procedures.
Assist and develop the Annual Compliance Audit Plan.
Assist with the development and presentations of audit findings for the Audit and Compliance Board of Trustees.
Specific Corporate Compliance Coordinator responsibilities include:
Perform medical record audits to ensure all services provided are accurately documented and reflected on the itemized statement and related documents, i.e., UB-04
Focused retrospective claims/records review.
Identify and develop process improvement initiatives from which government program-related problems can be resolved.
Ensure that any overpayments received from governmental payers are returned by coordinating the repayments and/or rebillings as identified from audits/compliance concerns.
Daily and or weekly website review of the Federal Register, Medicare and Fiscal Intermediary transmittals, bulletins, and memorandum.
Monthly Updates on the Recovery Audit Contractors and coordination of the claims denial appeals for all governmental payers (Medicare & Medicaid)
Identification of coding and billing problems as they pertain to APCs, DRGs, CPTs, and numbers of units to identify any waste, fraud or abuse.
Develop and present educational materials, based on audit findings to providers, management, and billing staff regarding correct coding guidelines and governmental regulations. (at least twice a year)
Communication of current and or upcoming governmental program regulations to designated hospital team members by either in-service, written, or verbal communication.
Perform Sanction Screening monthly checks of all employees, vendors, contract employees, volunteers, and medical staff.
Knowledge of STARK Law and ability to perform audits of contracts involving physicians and/or their family members that would trigger the STARK Law.Ability to identify STARK exceptions.
Knowledge of the False Claims Act.
Knowledge of EMTALA Law and review of monthly transfer refusals.
Additional Skill Set Requirements:
Proficient in payment review systems, hospital information systems, and coding methodologies.
Strong quantitative, analytical, and organizational skills.
Understand CMS Memos and Transmittals.
Understand medical records, hospital bills, and the charge master.
Utilize and understand computer technology.
Understand all ancillary department functions for the facility.
Communicate orally and in written format.
Understand reimbursement terms and payment methodology
Work with physicians, administrative staff, and department managers effectively.
Identify accurate revenue codes, CPT, and HCPCS codes for service/items.
Identify clerical errors, mistakes in interpretation, imprecise records, and inaccurate service code assignments.
Perform outpatient reviews for appropriateness of coding and charging.
Perform Inpatient reviews for medical necessity by applying integral criteria and review of NCD and LCD coverage.
Perform retrospective outpatient reviews for medical necessity by applying SIMS plus criteria and review of NCD and LCD coverage.
A. Bachelor of Science Degree w/5 years’ experience in health care accounting and/or business operation; OR 10 years’ experience in health care accounting and/or business operation.
B. Professional Coder preferred.
C. E/M Coding and Auditing Experience preferred.
D. Project management and presentation skills preferred.
E. Analytical, organizational, communication, and problem solving skills
PHYSICAL DEMANDS AND WORKING CONDITIONS:
·Medium Work as defined by the U.S. Department of Labor constitutes a maximum lift of 21-50 pounds on occasion and/or a maximum lift of 11-25 pounds on a frequent basis