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Position Summary
$64,854.40 - $100,526.40
To access our Benefits Guide/Plan Information, please click the link below:
http://www.sih.net/careers/benefits
Position Summary
- Responsible for performing appraisal and associated activities, including quality and compliance reviews, research and investigations of physician coding, documentation, and billing practices for adherence to policies, regulations, and best practices.
- Standards of Performance: Respect, Integrity, Compassion, Collaboration, Stewardship, Accountability, Quality
- Bachelor's degree, RN, RHIT, or RHIA
- In lieu of degree, 8 years of experience in auditing, coding, compliance or related field experience. Must have knowledge of physician documentation practices, CPT/HCPCS codes and modifiers, and healthcare regulations and enforcement. Experience working collaboratively with physicians and providing education is preferred. Knowledge of Rural Health Clinic regulation is a plus.
- Professional coding certification
- Technical Experience: 3 years
- Audits and investigations focus on detecting and preventing fraud and abuse.
- Provides feedback and education after audits and investigations regarding any identified coding, documentation, or billing issues.
- Support the development of corrective actions for deficiencies and the identification, quantification, and refund of any overpayments.
- Responds to inquiries from patients, physicians' management and staff.
- Conducts trend analysis.
- Reviews requests from government agencies, payors, and patients.
- Conducts research and provides education for documentation, coding, and billing issues and practices within the medical group.
- Collaborates with clinic managers, regional directors, coding, PFS, and IT to design and implement improvements to enhance compliance with policies and regulations.
- Performs evaluation and management and other specialized training, new provider orientation, and refresher training for staff and providers.
- Evaluates the effectiveness of education and response to audit recommendations.
- Research, interprets and communicates regulatory information and recommendations in various formats, including a compliance newsletter.
- Maintains knowledge of current trends and developments within areas of expertise through research and continuing education and shares learning.
- Identifies areas of risk within the Medical group for development of audit plans, the departments audit workplan, and education.
- Protects confidentiality and acts collaboratively to build relationships within the organization.
$64,854.40 - $100,526.40
To access our Benefits Guide/Plan Information, please click the link below:
http://www.sih.net/careers/benefits