COMPLIANCE SPECIALIST
Duke University - Durham, NC

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RHIA or RHIT or CCS certification with three years medical records/coding review experience preferred.

OCCUPATIONAL SUMMARY:

Evaluate, analyze and maintain an accurate and meaningful Coding database for the hospital services, reflective of patient mix and resource use through monitoring of coding compliance in accordance with the Office of Inspector General's Work Plan, education and internal audits.

JOB RESPONSIBILITIES:

Monitor data quality and optimal reimbursement to the hospital by performing prospective quality reviews for accurate coding and sequencing of diagnoses and procedures for inpatient and outpatient services using Center for Medicare and Medicaid coding guidelines, standards and regulations.

Conduct routine internal audits of coded data and physician documentation, report the results and recommend corrective action as needed.

Respond promptly to external audits and implement corrective action as appropriate.

Identify coding and billing risk areas for the hospital technical charges, conduct focused reviews, report the results, and implement corrective action as needed.

Interpret guidelines, applicable laws and regulations concerning hospital coding published in AHA Coding Clinic, AMA CPT Assistant, Federal Register, Medicare Bulletin, etc. Develop and maintain specific coding guidelines for inpatient and outpatient coding. Research problem areas and develop training material and coding aids for the coders.

Present timely, relevant educational programs to coding staff regarding coding updates, documentation and prospective payment system requirements. Participate in training of the coders and evaluate the effectiveness of the training.

Monitor productivity of coders assigned and provide feedback as requested.

Serve as a resource to the hospital on coding and documentation-related issues. Educate physicians and other health care professionals regarding documentation requirements for accurate coding and reimbursement. Educate Administration, Financial Management, Patient Resource Management, Revenue Managers, etc. regarding DRGs/APCs/APR-DRGs and the reimbursement methodologies.

Maintain/update the coding compliance manual for the hospital.

Perform other related duties as requested such as handling DRG invalidations and other coding/data related issues that result from peer review organization activities, and creating reports from 3M database for research and administrative purposes.

Minimum Qualifications
Education

Work requires knowledge of principles generally obtained through
completion of a bachelor's degree program. Experience

Work requires BA/BS and four years of administrative experience to
acquire competence in applying compliance, coding and auditing
principles as they relate insurance billing and collection.

OR ANY OTHER EQUIVALENT COMBINATION OF RELEVANT EDUCATION AND/OR
EXPERIENCE.

DUKE UNIVERSITY - 23 months ago - save job - block
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