Audit & Compliance Manager
The Central Business Office of Sinai Medical Group (SMG) is seeking an experienced Audit & Compliance Manger. The ideal candidate will provide training, support and assistance to Billing staff in the areas of charge capture, billing, coding practices and compliance in accordance with CMS and third party guidelines for the purpose of optimizing reimbursement and decreasing compliance liability. Responsible for compliance-related matters, provides in-services and education for staff and audits of physicians and staff. Possesses overall accountability for compliance, audits of SMG physicians, education and maintaining abreast of all billing and coding changes.
Essential Functions and Duties:
- Function as Compliance Manager for SMG Billing Services. Responsible for overall compliance and knowledge for billing and coding updates. Provides support to all SMG staff. Monitors and resolves charge capture issues, accuracy, and quality for all coding entries.
- Acts as liaison between physician and billing service for reimbursement and compliance issues.
- Reviews problem payments and explanations of benefits from the Third Party Collection team members. Assists with details regarding coding, bundling and accuracy in reimbursement methodologies from all payers.
- Proactively and retrospectively performs audits on physician documentation in accordance with the SMG audit and compliance plan. Responsible for ensuring that all audits are completed in a timely manner, accurately and with feedback provided. Utilizes specific audit tools and identifies trends, areas of concern and non-compliance. Provides audit results to appropriate parties including all corrective action plans and suggestions for improvement. Ensures that corrective action plans have been implemented and adhered to.
- Makes recommendations for the Director for subsequent meetings with department chairs, physicians and/or staff. Prepares monthly reports and submits same to appropriate parties on all audit findings, educational meetings, new provider orientations and changes in reimbursement methodologies in accordance with CMS and third party guidelines. Responsible for distribution of changes to all key stakeholders.
- Trains Phoenix staff on changes to billing, coding and collections guidelines. Reviews and analyzes non-clean claim reports, rejections dealing with billing including bundling and provides analysis of trends and concerns. Analysis is to be provided as training guidelines and also used in educational feedback to staff resulting in higher reimbursement and more accurate claim submission to our stakeholders.
- Responsible for developing and instructing professional medical coding curriculum, medical terminology, basic ICD-9 and CPT-4 for all staff at Phoenix Physician Services. All course work must be approved for continuing medical education (CEUs) by the American Academy of Professional Coders. Certifications will be presented to staff that have successfully completed the course work.
- Provides feedback on outcomes of audits for coding and billing staff to management in a standardized format allowing managers to share findings with staff. Monthly, quarterly and annual reports will be required for use in staff performance reviews, for education and training purposes and to ensure overall compliance.
- Demonstrates an in-depth knowledge of CPT, ICD-9 coding and medical terminology.
- Demonstrates a thorough understanding of correct coding principles.
- Demonstrates a thorough knowledge of CPC, AART or RHT with medical practice experience.
- Bachelor Degree in related field required; Masters Degree in related field preferred.
MINIMUM WORK EXPERIENCE:
- Minimum three (3) years related experience in a medical practice setting with direct physician contact.
- Minimum two (2) years conducting compliance reviews and audits for coding, charge capture, HIPAA with physicians and staff
- Two (2) years minimum progressive supervisory experience.
KNOWLEDGE, SKILLS AND ABILITIES:
- Demonstrated ability to train, coach and direct the work of coding staff.
- Demonstrated working knowledge of physician office claims coding in clinical areas of surgery, anesthesia, emergency room, primary care services.
- Excellent writing, verbal and interpersonal communication skills.
Certification in Physician Coding, CPC, CPMA, RHIT or CCS-P.
Special Instructions on how to apply:
To apply for this position please email your resume to firstname.lastname@example.org with the position title in the subject line. You may also fax your resume to (773)257-6290 attention Marisa Robertson. Applications can also be obtained in person at 15th and California from the Human Resources department Monday - Friday from 8:30am - 4:30pm. Sinai Health System is proud to be an Equal Opportunity Employer M/F/V/D. TTY number: 773-257-6289.