The UCSF Faculty Medical Group is responsible for implementing a comprehensive professional fee coding quality assurance strategy to ensure clinical providers, internal and external professional coder’s are in compliance with all applicable laws, regulations, policies and procedures, regarding professional fee billing.
This QA program will develop, implement and enforce University policy with the goal of minimizing the University’s legal and financial risks associated with professional fee billing, and be effective in preventing and detecting inappropriate, improper and fraudulent conduct. Consistent with University polices this program will establish reasonable compliance standards and procedures to be followed by UCSF employees. Employee education and compliance training will be required for those in positions involved with professional fee billing. Effective communication processes will be put in to practice to disseminate appropriate quality assurance information. A continuous monitoring and reporting system will be developed designed to detect compliance/non-compliance.
This position as a Coding Quality Analyst reporting to the Director of Revenue Management will perform careful, detailed analytical reviews of medical record documentation. Included in these reviews will be CPT and ICD-9 coding, claims posting accuracy, compliance with teaching physician rules, non-physician provider billing rules, physician NPI, UCSF ID and PTAN numbers, and any other information which has the potential to create risk and non-compliance with University and third party payer requirements.
The TBD Analyst will be responsible for the generation of written and graphic summaries of data reviewed. In addition, the Analyst will perform research tasks related to government regulations, carrier guidelines and other applicable laws as required. The Analyst will provide education and training on clinical documentation guidelines and participate in disseminating information on professional fee billing rules and guidelines for compliance with such requirements.
• BA/BS with a major in a related field and four years of experience in administrative analysis or operations research; or an equivalent combination of education and experience.
• Must be a certified professional coder in good standing with either AAPC or AHIMA.
• Must have a minimum of three years’ experience performing duties as a professional coder.
• The incumbent needs to be able to communicate rules and regulations in a clear and concise manner.
• Must be familiar with auditing and reviewing medical records.
• Knowledge of CMS regulations.
• Must have a comprehensive knowledge of CPT/ICD-9 coding and clinical documentation requirements.
• Must be able to speak in front of groups, which include faculty, residents and fellows, allied health professionals and administrative staff.
• Must have advanced skills with MS Excel, MS Office and database applications.
Note: Fingerprinting and background check required.
Physical Demands: requires sitting; standing; walking; climbing stairs; reaching up to shoulder height; reaching above shoulder level; repetitive movements of upper and lower extremities; differentiate color.
• Familiarity with electronic health record.
• Experience with practice management and billing information systems, preferably IDX, SMS, and Epic.
• University policies and procedures, SOM Compliance Plan and HIPAA.
• Familiarity with clinical practice operations and clinical provider work flows in an academic medical center.
• Experience with MD Audit application.
University of California San Francisco - 20 months ago