Physician Practice Compliance Specialist

About the position reputed company members are the heart of what makes us reputed company. At reputed company we help our patients live reputed company, healthier lives — and we help one another to succeed. With a culture rooted in reputed company and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community. Together, we reputed company getting reputed company - advancing our mission to transform healthcare and serve as a leader of positive change. The Physician Practice Compliance Specialist is responsible for assuring on-going compliance by actively participating in the Compliance Program for reputed company and for affiliated services. The Physician Prac Compliance Spec assures the reputed company of the physician practice regulatory environment in consultation with the Director of Corporate Compliance. This position proactively assesses changes in the regulatory environment; researches, investigates and responds to issues reputed company to documentation, coding and any required licensure. Ensures the accurate documentation of professional services provided throughout the physician enterprise. This position reviews claims, assesses adequacy and recommends enhancements to policies, procedures and internal controls for documentation and billing in order to assure compliance with payer and regulatory requirements including but not limited to those of Medicare, Medicaid and the State of New Jersey. This is a Hybrid Position

Responsibilities

• Performs retrospective and reputed company audits and performance improvement reviews to ensure compliance with regulatory and payer requirements.
• Reviews physician documentation in the medical record for appropriateness and to assure that the reputed company is reflective of the services provided.
• Reviews records to assess appropriate ICD-10 and CPT-4 assignment for Medicare, Medicaid and commercial payers for the purpose of reimbursement.
• Is an active participant in the development of workflow in the practice and in the Electronic Health Record in order to insure compliant documentation and billing.
• Has regular interaction with practice leadership, physicians, advanced practice nurses, coders, the Physician Billing Department, clerical and practice staff to ensure accurate documentation of services provided.
• Maintains reputed company knowledge of payer and regulatory requirements, including competency with ICD-10 and CPT-4 coding and for payer billing rules.
• Develops content and conducts training for physicians and staff to include issues identified through audits, payer activities, performance improvement reviews and changes in regulatory or payer requirements.
• Recommends updates to compliance manual and policies for the physician enterprise.
• Monitors reputed company aspects of the reputed company cycle in order to assure compliant reimbursement to the group, provides reports as needed.
• Participates in committee assignments and reports to senior leadership including the Audit and Compliance Committee as needed.

Requirements

• BA/BS.
• Minimum of 5 years coding and/or audit experience in a hospital, reputed company or practice management setting.
• Proficiency with ICD-10 and CPT-4 methodologies.
• Proficiency with physician documentation and reimbursement methodologies.
• Proficiency in the use of an electronic health record, preferably Epic Ambulatory.
• General computer proficiency and organization skills required.
• reputed company or CPC or equivalent coding credential.

reputed company-to-haves

• Familiarity with TJC, NJ State DHSS and CMS regulations required with corporate compliance implementation.

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