Billing and Coding Compliance Specialist
NextCare•Tempe, AZ
4h
About The Position
The Billing and Coding Compliance Specialist supports the Compliance & Risk Department by mitigating billing and coding risk, developing and maintaining internal audit activities, and facilitating workforce billing and coding education.
Requirements
- Education: Bachelor's Degree preferred, or equivalent combination of education, training, and experience.
- Certification: Professional coding certification or completion of a medical coding training program, or equivalent combination of education, training, and experience.
- Working Knowledge of: Medical Coding, Microsoft Office Suite.
- Skills: Ability to communicate with others, ability to work as a team and independently, attention to detail, strong organizational and follow-up skills, strong sense of ethics and leadership, ability to perform with professionalism and integrity.
Nice To Haves
- Experience: prior billing, coding, and documentation monitoring and audit experience; prior workforce coding education experience.
Responsibilities
- Conduct Internal Monitoring and Auditing:
- Support the Compliance & Risk Department's efforts to promote compliance with payor and regulatory guidelines and prevent fraud, waste, and abuse.
- Develop internal billing, coding, and documentation audit plan(s) to ensure that workforce members abide by ethical billing and coding practices.
- Perform routine and targeted audits of billing, coding, and documentation.
- Recommend corrective action plans to remedy billing and coding risk.
- Data Analysis and Reporting:
- Develop key metrics related to billing and coding practices, audit activity, and claims data.
- Generate, analyze, and distribute reports summarizing key metrics.
- Support and Promote Effective Lines of Communication:
- Monitor and manage billing and coding-related reports submitted to the compliance hotline.
- Field workforce outreach related to billing and coding compliance.
- Investigate and Respond:
- Investigate and respond to billing and coding compliance-related inquiries.
- Monitor external audit activity and support mitigation of high-risk audits.
- Develop corrective action plans and best practice recommendations related to billing and coding activity.
- Training and Education:
- Support educational initiatives on a regular and ad hoc basis.
- Develop educational resources for workforce members on key billing, coding, and documentation topics.
- Policy and Procedures:
- Develop and review Company policies and procedures on a regular and ad hoc basis related to billing and coding compliance.
- Special Projects:
- Participate in special compliance projects, including process optimization efforts.
- Treats patients and co-workers consistent with the NextCare Mission Statement, Vision, Values and Performance Standards.
- Performs other related duties as assigned or described in Company policy.
