Riverside Medical Group is seeking an experienced Compliance Manager. The Compliance Manager must exhibit an understanding of coding concepts, AMA, CMS/OIG/Federal/State regulations and guidelines.
Coding Compliance Chart Audit Reviews:
- Ability to audit and/or abstract code medical records for proper assignment of diagnoses specificity (including HCC/risk adjustment concepts) procedure codes, units, sites, modifiers, drugs, supplies, etc.
- Review and assign, appropriate E&M level based on utilization of 95 and 97 guidelines
- Ensure procedures, E&M and diagnosis reporting meet all AMA, both ICD9 and ICD10, HCC, Risk Adjustment Reporting, CCI, CPT, CMS and OIG Guidelines
- Assists/performs audit reviews for risk assessment purposes or as needed to complete benchmarks
- Assists/performs with internal and external audits for purposes of monitoring compliance to final resolution
- Performs focused Compliance Audit Reviews as outlined in internal Coding Compliance Plans
- New Provider chart reviews and documentation/coding education
- Prepares written reports of audit findings to present to Director, Physicians or other parties
Coding Compliance - Risk and Baseline Assessment:
- Applies knowledge of ethical coding principles and monitors revenue cycle activities to evaluate coding and identifies areas of needed review
- Utilizes a risk-based audit approach and establishes preliminary scope of reviews, incorporates patterns and trending analysis based on performing review and alerting the Director of any areas of identified concern
- Conducts investigations/audits reviews/communicates and works with other teams to resolve Coding Compliance issues
- Recognizes and reports problems, errors and discrepancies in medical records.
Coding Compliance Educational Efforts:
- Conducts audit reviews related to Coding Compliance initiatives and communicates/collaborates with Director and other teams regarding audit outcomes and educational areas of opportunity
- Communicates and meets regularly with Providers regarding coding/documentation findings and/or changes or compliance issues
- Meet with manager and assist in creating individual provider education plans tailored to provider's specific needs based on review findings
- Provides education to Providers regarding appropriate documentation
- Assist Mangers with management of special projects as assigned
- Demonstrates the ability to manage multiple projects
- Develops, maintains and implements tracking and reporting mechanisms related to compliance initiatives and projects
- Produces frequent summaries/reports regarding project status
- Ability to identify and report potential trends
- Works with outside resources to coordinate projects.
Education, Certification, Computer and Training Requirements:
- Proficient use of Microsoft Office Applications (Excel, Word, PowerPoint)
- Experience with the use of automated Encoder and Clinical Abstracting Systems preferred
- Associate's Degree minimum /Bachelor's Degree preferred
- Work related experience: 2-3 years minimum / 5 -8 years preferred
- Auditing experience: 1 year minimum / 2-3 years preferred
- Coding Certification - CPC, CCS-P, CCA, RHIT or RHIA- OR
- Auditing, Compliance & Billing or Practice Management Certifications -- CEMC, CPCO, CPMA, CCP-P, CHC, CPPM, etc. -- Required
- Knowledge of Medical Terminology, Anatomy & Physiology/ Medical Science required
- Knowledge of ICD-9, CPT, HCPCS coding skills and ability to abstract code required.
- Ability to access and research coding questions, efficiently and communicate solutions to providers and staff required.
- Ability to perform surgical chart reviews required
- Demonstrated proficiency with 1995 & 1997 auditing tools required
- Maintains a current level of OIG, Compliance, CMS, Stark, and Fraud & Abuse Regulations
- Maintains high level of specialty specific coding and auditing guidelines
- Maintains current knowledge of advances in coding, auditing and compliance
- Travel using personal vehicle is required to various locations (more than 1 mile)
Equal Opportunity Employer
Job Type: Full-time