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Physician Practice Compliance Specialist, Corporate Complian

Job ID 16129
Job Summary and Responsibilities: The Physician Prac Compliance Spec is responsible for assuring on-going compliance by actively participating in the Compliance Program for the Hackensack University Medical Group (HUMG) and for affiliated services. The Physician Prac Compliance Spec assures the integrity of the practice regulatory environment in consultation with the Chief Compliance Officer. This position proactively assesses changes in the regulatory environment; researches, investigates and responds to issues related to documentation, coding and any required licensure or accreditation. Ensures the accurate and timely documentation of professional services provided by HUMG. This position reviews claims, assesses adequacy and recommends enhancements to policies, procedures and internal controls for documentation and billing in order to assure compliance with payer and regulatory requirements including but not limited to those of Medicare, Medicaid and the State of New Jersey.1. Facilitates the timely submission of accurate claims through daily interaction with practice leadership, physicians, advanced practice nurses, coders, the Physician Billing Department, clerical and practice staff. 2. Performs retrospective and concurrent audits and performance improvement reviews to ensure compliance with regulatory and payer requirements. a. Reviews physician documentation in the medical record for appropriateness and to assure that the bill is reflective of the services provided. b. Reviews records to assess appropriate ICD-10 and CPT-4 assignment for Medicare, Medicaid and commercial payers for the purpose of reimbursement.3. Is an active participant in the development of workflow in the practice and in the Electronic Health Record in order to insure compliant documentation and billing.4. Maintains current knowledge of payer and regulatory requirements, including competency with ICD-10 and CPT-4 coding and for payer billing rules.5. Develops content and conducts training for physicians and staff to include issues identified through audits, payer activities, performance improvement reviews and changes in regulatory or payer requirements.6. Develops and maintains documentation and billing compliance manual for the physician practice.7. Monitors all aspects of the revenue cycle in order to assure complaint reimbursement to the group, provides reports as needed.8. Participates in committee assignments and reports to the Compliance Executive Committee as needed.9. Adheres to the standards identified in the Medical Center's Organizational Competencies.Working Conditions: Lifts a minimum of 10 lbs., pushes and pulls a minimum of 20 lbs. and stands a minimum of 2 hours a day.
Education, Knowledge, Skills and Abilities Required: 1. BA/BS.2. Minimum of 5 years coding and/or audit experience in a hospital, consulting firm or practice management setting.3. Proficiency with ICD-9 (ICD -10) and CPT-4 methodologies. 4. Proficiency with physician documentation and reimbursement methodologies.5. Proficiency in the use of an electronic health record, preferably Epic Ambulatory.6. General computer proficiency and organization skills required.Education, Knowledge, Skills and Abilities Preferred: 1. Familiarity with JCAHO, NJ State DHSS and CMS regulations required with corporate compliance implementation.Licenses and Certifications Required: 1. CCS or CPC or equivalent coding credential.Licenses and Certifications Preferred:
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