POSITION: Senior Billing & Coding Compliance Consultant

START SATE: ASAP

ESSENTIAL FUNCTIONS

• Serves as a professional billing integrity project leader, for all service lines, under minimal supervision, to develop and conduct individual or group presentations on coding, billing and compliance topics, based on new regulatory and/or professional coding industry information; pre-bill professional charge review findings; University-identified risk areas, or special projects requested by MSRDP leadership. This may include medical record audits, invoice analysis, and review of internal reports (e.g., charge analyzer, Code Correct) denials, external audit findings, etc. Responsible for the development and deployment of any quality improvement or corrective action plans required. Monitors for intended improvements or necessary alterations in action plans and reports progress to Supervisor and/or Manager.
• Develops and conducts standardized and/or specialty-driven new provider coding and compliance training (“onboarding”) for any service line, for physicians, advanced practice providers and other professional practitioners, in an individual or group setting. Ensures onboarding schedule is current and covered by team members, and regularly reviews onboarding platform and processes, working with Supervisor and team members to revise when indicated.
• Performs post-onboarding pre-bill review of professional charges, for any service line. Provides necessary feedback and follow-up with new providers to confirm understanding of procedure, modifier and diagnosis code assignment, as well as documentation requirements (teaching physician, working with advanced practice providers, etc.) to promote billing compliance. Assists Supervisor with ensuring any pending charges are reviewed and released in a timely manner according to MSRDP standards.
• Conduct independent reviews on adequacy of medical record documentation to support the procedure, modifier and diagnosis coding of any service line billed by any supported physicians, practitioners or billing staff, or areas that may pose a compliance risk and develop recommended solutions/action plans, which may include revised workflows and/or education. These reviews will require the application of critical thinking skills to summarize findings and develop action plans for risk mitigation. These reviews may be requested by MSRDP leadership, department/division leadership, medical residency coordinators, and others.
• Researches coding, documentation and reimbursement policy questions or problems submitted by physicians, practitioners, supported-departments, billing staff and others, to ensure compliance with specific payer and/or government regulations and optimum reimbursement. Prepares timely responses based on research outcome. Escalate issues to Supervisor or Manager, when indicated.
• In coordination with the Compliance Office, support and/or conduct Billing Compliance risk-based audits and resulting education.
• Completes charge review and follow-up EPIC work queue assignments, for any service line, within department timeliness standards, under minimal guidance of the supervisor. Assists supervisor in monitoring team work queues regularly to ensure timely resolution of charges/questions. Conducts quality assurance reviews for internal or contractor staff to verify the coding or other work is consistent and supported by regulations, University guidelines and/or MSRDP Medicine Audit Plan; with reporting and education, when indicated.
• Provides training to new internal or contractor staff on the use of audit software, EPIC, internal audit plan, work queue assignments, etc. as needed.
• Performs other duties, as assigned.

MINIMUM QUALIFICATIONS

EDUCATION/EXPERIENCE

High school diploma or equivalent and six (6) years of experience in a professional billing environment with emphasis on coding, auditing and/or compliance responsibilities is required. Certification in one of the following: Certified Professional Coder (CPC), Certified Coding Specialist (CCS) or a Certified Medical Coder (CMC) is required. Must have or obtain CPMA certification within 12 months of hire. Bachelor’s degree or registered nurse is desired.

KNOWLEDGE, SKILLS, & ABILITIES

• Must be able to work independently, or as a collaborating team member, to address a variety of complex issues in a timely fashion.
• Work requires strong verbal and written communication skills
• Work requires the ability to analyze medical records, billing history, payer rules and other data to validate regulatory compliance and organizational billing integrity
• Work requires the ability to evaluate data and develop action plans and/or educational presentations
• Must be flexible to adjust to the development and refinement of new processes and procedures.
• Work requires the basic skills to use Microsoft Office (Word, Excel, PowerPoint)
• Work requires flexibility, strong ability to organize tasks and prioritize workload
• Work requires the ability to interact effectively, professionally and respectfully with all levels of the organization
• Work requires the individual to be detail-oriented and able to manage a high volume of tasks with follow-through to completion
• Work requires knowledge of CPT, HCPCS and ICD-9-CM coding systems, as well as medical record documentation and accepted billing/coding standards.
• Work requires ability to interact effectively with various levels of faculty and staff to ensure billing/coding rules are met or exceeded