Catholic Health Initiatives Clinic Compliance Coordinator - Mercy Clinic Administration in DES MOINES, Iowa

Clinic Compliance Coordinator - Mercy Clinic Administration

Description

GENERAL SUMMARY:

The Compliance Coordinator works as a business partner with assigned clinics to ensure accuracy in CPT codes, ICD10 Codes, researching new codes, and determining accuracy of code changes. The Compliance Coordinator is responsible auditing medical records to ensure the documentation supports the coding.

ESSENTIAL FUNCTIONS:

  • Monitors, evaluates and makes recommendations consistent with the various regulatory agencies to ensure clinic billing and documentation activities are compliant.

  • Completes documentation audits according to federal and state health statutes, as well as third party control provisions.

  • Educates providers and staff on appropriate documentation to accurately reflect the medical services provided.

  • Acts as resource in various committees and meetings to coordinate changes in clinic processes.

  • Reviews coding changes for appropriateness when resubmitting denied claims.

  • Tracks/trends denial reasons and works with assigned clinics to provide ongoing education on billing rules & regulations.

  • Collaborates with AEHR team to ensure electronic record templates and guidelines meet regulatory standards.

  • Monitors provider E/M profiles and conducts audits and education to ensure appropriate reimbursement and compliance with all regulatory guidelines.

  • Identifies compliance issues and analyzes practice patterns recommending changes to policies and procedures.

  • Supports the implementation of necessary changes with clinical departments through education of providers and staff.

  • Maintains accuracy and completeness of provider audits in the auditing software application.

  • Maintains current knowledge of standards, patient safety goals and other regulatory requirements.

  • Responds to questions from providers, managers, billing office and others related to CPT and ICD coding, rules & regulations, reimbursement, and documentation requirements.

  • Evaluates and responds to inquiries from governing bodies/regulatory agencies (i.e., RAC, CERT, and Probe audits).

  • Performs business analysis to identify and trend areas of compliance and provides reports regarding areas evaluated.

  • Applies knowledge and understanding of documentation, informatics, and nomenclatures in the medical records.

  • Acts as a liaison between clinics and Administration.

  • Utilizes effective problem solving skills in identifying strengths and weaknesses, identifying obstacles to progress and creatively defines problem solving approaches.

  • Submits status reports toward project goals as requested.

  • Appropriately escalates issues that may compromise patient safety, or adversely impact clinical work flow or project timelines, goals, or budget.

  • Builds and promotes effective working relationships with multiple departments and disciplines.

  • Performs other duties as assigned or as necessity dictates.

Qualifications

MINIMUN KNOWLEDGE, SKILLS AND ABILITES REQUIRED:

  • Minimum two years CPT, ICD9/ICD10 billing knowledge required.

  • Minimum of two years clinics experience preferred.

  • Proficient in use of computer applications, i.e. MS Office programs.

  • Demonstrates knowledge of documentation standards according to regulatory rules.

  • Work requires a profes­sional level of knowledge in health care (i.e. nursing, coding, billing), with teaching/education experience preferred.

  • Demonstrates ability to analyze CPT and ICD codes to ensure accuracy and consistency between the medical record and claim submission.

  • Basic Life Support (BLS) for the Healthcare Provider certified or obtained within three (3) months of hire.

Job Professional Non-Clinical

Primary Location IOWA-DES MOINES-MEDICAL ADMINISTRATION

Daily Schedule Days

Scheduled Hours per 2-week Pay Period 80

Weekends Required None

Req ID: 2018-R0166850

We’re an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.