- Continuously monitors Federal and State (Medicare and Medicaid) program advisories to ensure that MPBS systems and practices are functioning in accordance with regulatory guidelines. Maintains a repository of program memorandums by payer (both governmental and commercial) detailing coding and billing practice requirements.
- Develops and delivers communication to client departments/clinicians regarding changes in regulatory environment and their potential impact on revenue optimization.
- Exemplifies Guest and Staff Relations standards in all activities in areas of service, resource utilization, high quality outcomes and effective communication and holds staff accountable for conformity with those standards in all activities.
- Facilitates responses to all payer audits, including but not limited to: ADR's, CERTS, RACs, medical record requests, coding issues, and LMRP's. Responsible for the daily oversight and the transfer of data between the MPBS and the impacted providers/entities, and ensures that inquiry responses are completed within mandated timelines.
- Identifies potential areas of regulatory vulnerability and risk for MPBS related processes and work product. Researches, writes and obtains necessary approval for changes to MPBS policies and procedures for the resolution of process and work product issues to the MPBS management team.
- Prepares and submits weekly issue logs and tracking reports detailing State and Federal regulations and commercial payer, regulatory guidance, audits, denials, advisories and any other related communication that may impact MPBS systems and practices. Represents MPBS on MedStar Compliance Committees. Manages and maintains MPBS response to MedStar Compliance Committees related audits/reviews or other risk assessment activities.
- Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards and safety standards. Complies with governmental and accreditation regulations.
- Participates in multidisciplinary quality and service improvement teams as appropriate. Participates in meetings, serves on committees and represents the department and hospital/facility in community outreach efforts as appropriate.
- Performs other duties as assigned.
- Bachelor's degree in health related or business administration preferred
- Any other combination of relevant education and/or experience will be accepted.
- 3-4 years progressively responsible experience in operational, clinical, business management or similar field required
- Excellent project management skills.
- Strong knowledge of healthcare compliance, regulatory law, CMS billing rules, and OIG projects preferred.
- High level of independent judgment and problem-solving skills.
- History of effective working relationships with other health professionals.
- Excellent verbal and written communication skills.
- Strong analytical, report design and organizational skills.
- Strong public speaking and presentation skills.
- Proficiency in computer software programs including MS Office.
- Ability to work and thrive in team oriented, production and deadline driven work environment.
- Strong emphasis on teamwork - our associates feel connected to each other and our mission as an organization. In return, our effective team environment generates positive patient outcomes and high associate satisfaction ratings that exceed the national benchmark.
- Strategic focus on equity, inclusion, & diversity - we are committed to equity for all people and communities. We continue to build a diverse and inclusive workplace where people feel a sense of belonging and the ability to contribute to equitable care delivery and improved community health outcomes at all levels of the organization.
- Comprehensive total rewards package - including competitive pay, generous paid time off, great health and wellness benefits, retirement savings, education assistance, and so much more.
- More career opportunities closer to home - as the largest healthcare provider in the Baltimore-Washington, D.C. region, there are countless opportunities to grow your career and fulfill your aspirations.
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Regulatory Auditor - Washington, United States - MEDSTAR HEALTH
Description
General Summary of Position
MedStar Physicians' Billing Services is currently seeking an experienced Regulatory Auditor to join our team The qualified candidate must be a CPCMedical Coder that thrives working independently in a fast-paced environment.
Position is REMOTE but we are seeking a local candidate to the DMV Area (Washington DC, Maryland, Virginia).
Join one of the largest health systems in the area and enjoy the benefits of a comprehensive benefits package including paid time off, health/vision/dental insurance, short & long term disability, tuition reimbursement and the benefits of remote work capability.
Job Summary - Receives, documents, and monitors regulatory guidance from governmental and commercial payers. Coordinates required change to ensure that MPBS systems and practices adhere to all specifications while maintaining revenue cycle optimization. Facilitates MPBS response to audit inquiries. Develops educational materials and programs to promote client provider accuracy and completeness of medical documentation, coding, and billing in accordance with Federal, State and payer regulatory requirements.
Primary Duties and Responsibilities
Minimum Qualifications
Education
Experience
Knowledge, Skills, and Abilities
Why MedStar Health?
At MedStar Health, we understand that our ability to treat others well begins with how we treat each other. We work hard to foster an inclusive and positive environment where our associates feel valued, connected, and empowered. We live up to this promise through:
About MedStar Health
MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It's how we treat people.
MedStar Health is an Equal Opportunity (EO) Employer and assures equal opportunity for all applicants and employees. We hire people to work in different locations, and we comply with the federal, state and local laws governing each of those locations. MedStar Health makes all decisions regarding employment, including for example, hiring, transfer, promotion, compensation, benefit eligibility, discipline, and discharge without regard to any protected status, including race, color, creed, religion, national origin, citizenship status, sex, age, disability, veteran status, marital status, sexual orientation, gender identity or expression, political affiliations, or any other characteristic protected by federal, state or local EO laws. If you receive an offer of employment, it is MedStar Health's policy to hire its employees on an at-will basis, which means you or MedStar Health may terminate this relationship at any time, for any reason.
