COMPLIANCE SPECIALIST-Remote (Durham, NC, US, 27710)

Role Summary

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.

Patient Revenue Management Organization

Pursue your passion for caring with the Patient Revenue Management Organization, which is the fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions for Duke Health.

This position is 100% remote. All Duke University remote workers must reside in one of the following states:

North Carolina, Alabama, Arizona, Connecticut, District of Columbia, Florida, Georgia, Illinois, Iowa, Kentucky, Louisiana, Maine, Michigan, Missouri, Montana, New Hampshire, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Washington.

General Description of the Job Class

The Compliance Specialist Auditor will perform coding quality audits of inpatient records to assure appropriateness and accurate code assignments in accordance with Center of Medicare and Medicaid (CMS) guidelines and to provide ongoing feedback and identification of the education needs for the providers and staff.

Examples

• Interventional Radiology
• Cardiothoracic
• Ortho (Foot and Ankle Specifically)
• Critical Care
• Observation Services
• ED
• Edits/Denials
• Gen Surg
• Trauma
• Peds
• GI
• Anesthesia
• Good work ethic
• Strong sense of responsibility
• Ability to work independently

Knowledge of

ICD-10-CM and CPT/HCPCS coding guidelines to effectively apply to outpatient diagnoses and procedures.

Knowledge of prospective payment systems and thorough understanding of DRG/APC reimbursement methodologies and coding validation.

Understanding of anatomy, physiology, pharmacology and medical terminology.

Ability to

• Achieve thoroughness and accuracy in task completion
• Analyze detailed information to determine appropriate compliance with coding and reimbursement regulations
• Establish and maintain effective working relationships
• Communicate clearly and concisely
• Identify trends within audits
• Systems
• Epic experience preferred; 3M 360 CAC, Audit Manager
• MS Office Applications (Word, Excel, Visio, Access, PowerPoint)

Distinguishing Characteristics of this Level

All job performance relates to the strategic goals of DUHS and its entities. All DUHS staff are expected to live Duke’s Core Value: Caring for our patients, their loved ones and each other. Demonstrating commitment to excellence, safety, integrity, diversity and teamwork.

Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Responsibilities

PRIMARY FUNCTION: Monthly QA Audits of PB coders.

Monitor data quality and optimal reimbursement to the hospital by performing retrospective quality audits for accurate coding of ICD-10-CM diagnoses or CPT-4 procedures (and appropriate use of modifiers) for professional and outpatient services using Center for Medicare and Medicaid coding guidelines, standards and regulations.

• Should be able to adequately utilize coding resources to back up any findings within audit
• Responsible for performing medical record reviews to ensure that documentation supports the assigned codes.
• Performs focused/integrated audits; when necessary
• Serves as subject matter coding expert
• Collaborates with outside departments
• Serves as the expert for coding questions
• Identify coding and billing risk areas, report results to PB Operations for action plan

Analyzes coded records for compliance with federal, state and third party insurer rules and regulations and note trends.

• Excellent verbal and written communication
• Sets the tone for ethical behavior, actively models ethical behavior to set an example for others
• Identifies issues and discusses them in a timely and constructive manner to obtain a rapid and effective resolution

Performs other related duties incidental to the work described herein and other related work as assigned.

Essential Physical Job Functions

Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.

Requirements

• HIGHLY SOUGHT AFTER SKILLS
• HCC coding/auditing
• Multi-Specialty Coding/Auditing
• Education

High School Diploma, required

• Four (4) years of coding review experience in applying compliance, auditing and coding principles as they relate to professional coding and billing
• Or equivalent combination of relevant education and/or experience.

Degrees, Licensure, and/or Certification

• Certified Professional Coder (CPC), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA) and/or Certified Coding Specialist (CCS), required
• Certified Risk Coder (CRC), Certified Professional Medical Auditor (CPMA)- Added bonus credentials