POSITION SUMMARY/RESPONSIBILITIES
Works to utilize the department's resources for analytical auditing and monitoring activities related to University Health's compliance program. Additionally, the position is responsible for assisting with the development and execution of the Compliance Work Plan under the supervision of the Chief Compliance/HIPAA Officer. Conducts complex operational and compliance audits from inception to completion in accordance with departmental practices and procedures. Primarily, the scope of audits and reviews will be in the areas of coding, billing, medical record documentation, claims, clinical data, and reports as they relate to the revenue cycle. Will routinely review and evaluate University Health's internal control structures within revenue cycle activities to ensure they adequately prevent and detect errors, fraud, waste and abuse. Assists with other audits and investigations with approval from the Chief Compliance/HIPAA Officer. Performs duties and assignments promptly and efficiently. Strives to protect the department's reputation for creditability and objectivity. Maintains good public/working relations with other University Health executives, members of the Board of Managers, co-workers, employees, doctors, patients and guests. Handles all personal contacts with professionalism, efficiency and integrity while preserving the confidential nature of information. EDUCATION/EXPERIENCE
Bachelor's degree from an accredited college or university strongly preferred. Certification from AAPC or AHIMA as a Certified Professional Coder (CPC) and Certified Professional Medical Record Auditor (CMPA), Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA), or a Registered Health Information Technician (RHIT) is required. Minimum three years' experience performing various claims validation reviews in a multi-specialty outpatient/Ambulatory Surgery Center is strongly preferred. Expert knowledge of ICD, CPT, HCPCS coding classifications required and DRG, APC and ASC payment methodology preferred.
