- Creates data reporting and visualization tools to facilitate the trending of compliance-related coding/billing data to ensure the organization is meeting its government and industry compliance standards for physician services.
- Uses data reporting and visualization tools to analyze trends to identify and potentially resolve compliance risks and opportunities.
- Complete external audit and payor reviews such as Governmental Recovery Audits. Maintain work queue in IHIS as well as tracking and reporting over/ under payments. Collaborates with Accounting to assist in completing any applicable appeals when necessary.
- Supports the Average Days to Close Encounters policy, including monitoring data reports and communicating regularly with physicians.
- Conduct reviews of patient charts for designated group faculty to determine accurate CPT, HCPCS procedure and professional supply codes and ICD-9-CM diagnosis codes used for billing services provided by physicians and licensed non-physician providers.
- Keep current with medical compliance and reimbursement policies, such as medical necessity issues and correct coding issues.
- Provide training and education on coding, documentation and other compliance issues to physicians, non- physician providers, and staff on an ongoing basis.
- Conduct research on various compliance and documentation issues.
- Respond to and track third party inquiries regarding level of service coding by the physicians.
- Distribute the OSUP Compliance Program to all persons and entities identified as involved in documenting, coding and billing for services within the designated group.
- Review explanations of benefits (EOBs) from payers, evaluating denied claims and filing appeals for denied claims.
- Serve as a liaison between coding and billing personnel and physicians.
- Prepare weekly reports of audit and education activities as needed.
- Develop tools for physician use to aid with documentation and billing, as requested.
- Participate on committees or work groups as needed.
- Ability to perform functions using job-related software and systems.
- Attendance, promptness, professionalism, the ability to pay attention to detail, cooperativeness with co-workers and supervisors, and politeness to customers, vendors, and patients.
- Other duties or special projects as assigned.
- Preferred Certification as a CPC, CCS-P, RHIT or RHIA; will consider someone not CPC, but they must obtain certification within the first year of employment.
- Minimum of two years experience with coding and reimbursement for physician services.
- Skill in exercising initiative, judgment, discretion and decisionmaking to achieve organizational objectives.
- Skill in establishing and maintaining effective working relationships with physicians and other mid-level providers.
- Analytical ability to gather and interpret data and develop, recommend, and implement solutions.
- Ability to create and navigate data reporting and visualization software to aid in analysis.
- Strong writing and presentation skills, solid interpersonal communication and facilitation skills are essential.
- Must have knowledge of physician auditing practices and an in-depth knowledge of CPT, ICD-9-CM diagnosis codes and HCPCS procedure and professional supply codes used for billing services provided by physicians and non-physician providers.
- Knowledge of third-party fee profiles and reimbursement requirements is preferred.
- Must have knowledge of a variety of computer software applications in word processing, spreadsheets, database, and presentation software (MSWord, Excel, Access, PowerPoint).
- A wide degree of creativity and latitude is expected.
- Work effectively with individuals and teams, able to contribute to and influence management.
- Must be able to interact and communicate with individuals at all levels of the organization.
- Ongoing: Maintains current licenses and certifications.
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Senior Compliance Analyst - Columbus, United States - Ohio State University Physicians, Inc.
Description
Overview:
**Position is remote for OH residents only**
Looking to join and lead a dynamic team at Ohio State University Physicians where excellence meets compassion?
Who we are
With over 100 cutting-edge outpatient center locations, dedicated to providing exceptional patient care while fostering a collaborative work environment, our buckeye team includes more than 1,800 nurses, medical assistants, physicians, advanced practice providers, administrative support staff, IT specialists, financial specialists and leaders that all play an important part. As an employee of Ohio State University Physicians (OSUP), you'll be an integral part of a team committed to advancing healthcare, education, and professional growth.
Our culture
At OSUP, we foster a culture grounded in the values of inclusion, empathy, sincerity, and determination. We meet our teams where they are, coming together to serve each other and our community.
Our benefits
We know that having options and robust benefit plans are important to you. OSUP prioritizes the wellbeing of our team and thats why we offer our employees a flexible, competitive benefit package. In addition to medical, dental, vision, health reimbursement accounts, flexible spending accounts, and retirement, we also offer an employee assistance program, paid time off, holidays, and a wellness program designed to support our employees so they can live their best lives.
Responsibilities:USD $63, USD $94,695.00 /Yr.
Senior Compliance Analyst professionals in Columbus
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Rami Abu-Attiyeh
Senior Credit Analyst | Team Lead
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Robert Giacalone
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