Education/Training Spec II - Physician Billing Compliance

University of Florida • Gainesville, FL

9h • Onsite

About The Position

The Compliance Education & Training Specialist provides education & training to providers and non-providers and shares efforts/responsibility for planning, teaching, evaluating, and developing Physician, Non-physician practitioner, and staff education for the Office of Physician Billing Compliance, College of Medicine (COM-PBC). Includes on-line educational modules that meet the requirements of the College Compliance Plan. Emphasis on regulations concerning documentation requirements for state and federal payors (includes Medicare and Florida Medicaid). Instructs both staff and physicians in coding requirements. Performs federally required searches for ineligible/sanctioned persons. This position reports directly to the Physician Billing Compliance Director. Provides education to providers (physicians, advanced practice registered nurses (APRNs), and physician assistants (PAs)) regarding documentation, reimbursement, and compliance and provides technical assistance and educational materials for both annual general update, and new provider education. Compiles specialty specific packets as appropriate. Assists in routine, new provider follow up audits, downstream audits, special investigations, as well as external requested reviews. Tracks educational activities of the Office of Physician Billing Compliance, including the updated list of providers and staff with date educated. Enters information into the Compliance educational database. As part of the Education and Training team, responsible for coordinating with online developers, maintenance of database, coordinating with departmental administrators to ensure that all personnel in College and Faculty Group Practice are identified and that the list is current, and notifying departmental contacts of those who have not completed required education by deadline. This position is responsible for tracking clinical personnel required to meet educational requirements, and track those employed by the College, but have been exempted as non-clinical personnel. This takes extensive coordination and interaction with department administrators – more than 6,000 individuals completed annual update training in 2020. Assists in conduct of regular compliance education and coding classes, including the weekly new employee orientation (non-provider). Conducts searches for sanctioned persons in federal databases in accordance with federal requirements and maintains databases to demonstrate University efforts. Employment of a federally sanctioned person is a violation of federal law. Assists in review of Encounter forms and templates. Coordinates the Compliance awareness month with Shands Compliance Team. Assists college administrators in resolving specific educational or training problems and in disseminating information in regard to federal and state regulations and UF Health and College policies. Assists the Compliance Audit Specialists (Auditors), when needed, by conducting one-on-one educational sessions with physicians, APRNs, and PAs on both initial training, and/or follow-up education. This requires a credentialed coder (in consideration of risk to University for failure in either appearance or in fact to distribute accurate information on the complex rules of federal and state regulations regarding reimbursement for physician services.) Assists in planning process, may participate in information gathering, meetings, compilation of work papers, monitoring provider billing services, compilation of findings. Contributes to the assessment of risks and compilation of audit narrative describing systems and internal controls. Develops and stays up to date on understanding of the operations, system processes, and procedures used in the areas being audited.

Requirements

• Bachelor's degree in an appropriate area and four years of relevant experience, or an equivalent combination of education and experience.
• Proficiency with medical terminology.
• Proficiency with procedural coding (including Level II HCPCs) and diagnosis coding.
• Proficiency with Evaluation and Management guidelines and CMS Teaching Physician regulations.
• Demonstrated ability to gather data, compile information, and prepare reports for auditing.

Nice To Haves

• Previous compliance auditing experience
• Experience and comfortability presenting education information to providers in a large setting and one-on-one
• Experience with Medicare, Medicaid, and Tricare/Champus regulations pertaining to billing and reimbursement
• 6 or more years of billing/coding experience
• Certified in Healthcare Compliance (CHC)
• Experience with PowerPoint and Access in a Windows environment.
• Experience with management information systems and medical software.

Responsibilities

• Provides education to providers (physicians, advanced practice registered nurses (APNs), and physician assistants (PAs)) regarding documentation, reimbursement, and compliance.
• Provides technical assistance and educational materials for both annual general update, and new provider education.
• Compiles specialty specific packets as appropriate.
• Assists in routine, new provider follow up audits, downstream audits, special investigations, as well as external requested reviews.
• Tracks educational activities of the Office of Physician Billing Compliance, including the updated list of providers and staff with date educated.
• Enters information into the Compliance educational database.
• Coordinates with online developers, maintenance of database, and departmental administrators to ensure all personnel are identified and have completed required education.
• Notifies departmental contacts of those who have not completed required education by deadline.
• Tracks clinical personnel required to meet educational requirements, and track those employed by the College but exempted as non-clinical personnel.
• Assists in conduct of regular compliance education and coding classes, including the weekly new employee orientation (non-provider).
• Conducts searches for sanctioned persons in federal databases in accordance with federal requirements and maintains databases to demonstrate University efforts.
• Assists in review of Encounter forms and templates.
• Coordinates the Compliance awareness month with Shands Compliance Team.
• Assists college administrators in resolving specific educational or training problems and in disseminating information regarding federal and state regulations and UF Health and College policies.
• Assists the Compliance Audit Specialists (Auditors), when needed, by conducting one-on-one educational sessions with physicians, APRNs, and PAs on both initial training, and/or follow-up education.
• Assists in planning process, may participate in information gathering, meetings, compilation of work papers, monitoring provider billing services, compilation of findings.
• Contributes to the assessment of risks and compilation of audit narrative describing systems and internal controls.
• Develops and stays up to date on understanding of the operations, system processes, and procedures used in the areas being audited.

Benefits

• Low-cost State Health Plans: Medical, Dental, and Vision Insurance
• Life and Disability Insurance
• Generous Retirement Options
• Comprehensive Paid Time Off Packages with 10+ paid holidays, paid family, sick and vacation leave
• Access to UF Training & Organizational Development programs, leadership development, LinkedIn Learning, and more
• Tuition Assistance through the UF Employee Education Program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level