Compliance Analyst I

Palmetto Health - Columbia, SC (30+ days ago)3.9

Job Details
High School/GED
3 years of experience required
JobSummary: Thisposition conducts and coordinates audits of Palmetto Health-USC Medical Groupproviders' documentation to ensure accuracy of services billed for acute andambulatory services. Prepares reports to be presented to providers based onthose audits. All team members are expected to be knowledgeable and compliantwith Palmetto Health-USC Medical Group's values of compassion, dignity,excellence, integrity, and teamwork.
Education: High School Diploma or equivalent required. College degreepreferred.

Experience: At least 3 years of related work experience inprofessional coding and/or auditing medical records. Must have experienceworking with CPT, ICD-9, IDC-10, E/M Documentation Guidelines (1995/1997), CCIedits, Medicare LCDs, state and federal regulations as well as payor billingrequirements.

Number and Type of Team Members Supervised: None

Licensure, Registry or Certification Required: Musthave one of the following: CPC, CCS, RHIT, RHIA. Must be ICD-10 Certified.

Special Training: Analytical skills and close attention to detail. Knowledgeof CPT, ICD-9, and ICD-10, knowledge of medical terminology, oral and writtencommunication, knowledge of Federal and state compliance regulations,organizational skills, report preparing skills, and ability to maintain confidentiality.Must be computer literate. Must haveexperience with Microsoft applications (i.e. Word, Excel). Experience with encoder applicationspreferred. Surgical coding background preferred.

Key Responsibilities:
  • Conducts and coordinates routinely scheduled audits ofPalmetto Health-USC Medical Group providers' documentation involved with professionalfee billing, for accuracy of coding and physician physical presence. Theseaudits consist of ambulatory Evaluation and Management services and officeprocedures as well as hospital admissions, subsequent visits, hospitalprocedures, and all other services performed or supervised by PHUSCMGproviders. The auditor will review medical record documentation to identifyunder-coded and up-coded services; prepares reports of findings and meets withproviders to provide education and training on accurate coding practices andcompliance issues.
  • Interacts with physicians and other patient care providersregarding billing and documentation policies, procedures, and regulations;obtains clarification of conflicting, ambiguous, or non-specific documentation.
  • Trains, instructs, and/or provides technical support tomedical providers and Medical Coding Analysts as appropriate regarding codingcompliance documentation, and regulatory provisions, and third party payerrequirements.
  • Attends coding conferences, workshops, and in-house sessionsto receive updated coding information and changes in coding and/or regulations.
  • Ensures strict confidentiality of financial records.
  • Performs miscellaneous job-related duties as assigned.