Audit and Billing Compliance Specialist

University of Arkansas for Medical Sciences • Little Rock, AR

1d • Onsite

About The Position

The Audit & Billing Compliance Specialist works under the general direction of the Clinical Billing Compliance Director and reviews medical records and billing system programs to determine coding and billing accuracy and to ensure that all federal and state guidelines for coding and billing are followed. Conducts inpatient and outpatient coding and billing audit functions according to the audit plan schedule with the focus on hospital billing according to the Center for Medicare and Medicaid Systems (CMS) laws and regulations. Provides education and training to coding staff as well as ancillary department staff.

Requirements

• Baccalaureate degree plus 3 years’ experience in inpatient and outpatient coding/auditing functions OR High School diploma plus 7 years’ experience in inpatient and outpatient coding/auditing functions.
• Must have one of the following CURRENT coding certifications: Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC), Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT).
• Must have demonstrated ability to present information verbally and have strong written communication skills with attention to detail.
• Must have the ability to make reasonable decisions based upon the information gathered, interpret regulatory information and deliver learned information to physicians.
• Must have the ability to explain the financial impact to the hospital.
• Persons must have proof of legal authority to work in the United States on the first day of employment.

Nice To Haves

• Prefer degree in Health Information Management, Healthcare Administration, or related field

Responsibilities

• Conducts inpatient and outpatient coding & billing audit/monitoring functions according to the audit plan schedule, with focus on hospital billing according to the Center for Medicare and Medicaid Systems (CMS) laws and regulations.
• Audits departmental systems and processes to ensure that they comply with state and federal laws and regulations.
• Provides audit results to the affected areas and educates staff regarding errors.
• Prepares detailed audit reports for the Clinical Billing Compliance Director and Associate Vice Chancellor review as well as dissemination to Hospital Administration, Revenue Cycle and Department Managers as appropriate.
• Develops and presents educational in-service programs on new regulatory issues for all inpatient and outpatient coders.
• Keeps abreast of current trends, problems and activities relating to coding.
• Proficient and keeps current with all COM/UAMS coding and billing policies and procedures and applicable federal and state regulations.
• Serves as a resource to assigned departments on current regulations, coding issues, charge and billing issues, facility charging and billing as well as regulatory concerns.
• Disseminates regulatory and compliance information to Ancillary departments and Clinic areas as necessary.
• Performs specific audits outside the audit plan schedule as needed (to include, but not limited to, Office of Inspector General (OIG) audits, Medicare Administrative Contractor (MAC) audits, Recovery Audit Contractor (RAC) audits, Medicaid Integrity Contractor (MIC) audits, etc.).
• Reviews RAC audits for any Diagnosis-Related Group (DRG) issues as needed.
• Writes RAC appeal letters for DRG changes.
• Communicates with regulatory agencies (Medicaid, Novitas Solutions, etc.) as necessary for clarification of regulations or for assistance with audit issues or coding issues as needed.
• Participates in special projects as assigned by the Senior Director of Clinical Billing Compliance and/or the Associate Vice Chancellor for Institutional Compliance/Chief Compliance Officer and other duties as assigned.

Benefits

• Health: Medical, Dental and Vision plans available for qualifying staff and family
• Holiday, Vacation and Sick Leave
• Education discount for staff and dependents (undergraduate only)
• Retirement: Up to 10% matched contribution from UAMS
• Basic Life Insurance up to $50,000
• Career Training and Educational Opportunities
• Merchant Discounts
• Concierge prescription delivery on the main campus when using UAMS pharmacy

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree