Medical Billing and Coding Compliance Analyst

CPSI

About The Position

Conducts compliance audits on medical billing functions performed by TruBridge employees or TruBridge contracted or sub-contracted staff. Provides informal guidance to billers and solves straightforward problems. Discusses findings with Compliance Consultant and/or Department Leader to identify needs for corrective and preventative action, such as education, development of policies and procedures, changes to settings within the billing software or electronic health record. Refers to Federal, State, and payer-specific billing guidelines as well as internal policies and procedures when conducting these audits. These Goals and objectives are not to be construed as a complete statement of all duties performed; employees will be required to perform other job-related duties as required. Goals and objectives are subject to change. All activities must be in compliance with Equal Employment Opportunity laws, HIPAA, ERISA and other regulations, as appropriate. Essential Functions: In addition to working as prescribed in our Performance Factors specific responsibilities of this role include: Conduct audits upon claims as prescribed in the Medical Billing and Coding Compliance audit plan, especially upon changes made to claims by billers employed, contracted, or subcontracted by the Company Conduct research to answer billing questions or concerns that arise while conducting audits Document audit findings within the tool developed for such; discuss questions with the department’s Billing and Coding Compliance Consultant and/or the Department Leader Suggest possible policies and procedures or educational materials to be developed, or possible changes to be made within the billing system or client’s electronic health record Other duties as assigned Minimum Requirements: Education/Experience/Certification Requirements 2 years Medicare hospital billing experience (within the last 12 months) Prior experience in conducting research regarding Medicare/Medicaid billing concepts Excellent communication (written and oral) and interpersonal skills. Strong organizational, multi-tasking, and time-management skills. Detail-oriented and able to follow through on issues to resolution. Able to act both independently and as a team member. Comfortable speaking in a group setting Able to present audit findings in a confident and constructive manner Able to teach billing compliance concepts to an individual Preferred Qualifications: 5 years prior Medicare/Medicaid hospital billing experience preferred Acute Hospital and CAH Medicare/Medicaid billing experience preferred Prior billing compliance auditing experience favorable Excel experience helpful Working Environment/Physical Demands Working Environment: General office environment: Works generally at a desk in a well-lighted, air-conditioned cubicle/office, with moderate noise levels. Periods of stress may occur. Physical Demands: Activities require a significant amount of sitting at office and work desks and in front of a computer monitor. Some walking and standing relative to interaction with other personnel. Travel Requirements: NONE None Occasional Moderate Frequent Very Frequent (25% or Less) (25% - 40%) (40% - 80%) (80% or more) Other possible Unofficial Titles: Unofficial titles may be given by the manager and used for calling cards and email signatures. Note: Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time. This document does not create an employment contract, implied or otherwise. It does not alter the "at will" employment relationship between the company and the employee. Individual Contributor What’s it like to work for TruBridge? You’ll help connect providers, patients and communities with innovative solutions that create real value by supporting both the financial and clinical sides of healthcare delivery. You’ll be part of a remote team that’s encouraged to push boundaries and look at things differently. And you’ll contribute to supporting providers in delivering the best care possible for their communities. Are you ready to help us clear the way for care? Explore opportunities with TruBridge.

Requirements

2 years Medicare hospital billing experience (within the last 12 months)
Prior experience in conducting research regarding Medicare/Medicaid billing concepts
Excellent communication (written and oral) and interpersonal skills.
Strong organizational, multi-tasking, and time-management skills.
Detail-oriented and able to follow through on issues to resolution.
Able to act both independently and as a team member.
Comfortable speaking in a group setting
Able to present audit findings in a confident and constructive manner
Able to teach billing compliance concepts to an individual

Nice To Haves

5 years prior Medicare/Medicaid hospital billing experience preferred
Acute Hospital and CAH Medicare/Medicaid billing experience preferred
Prior billing compliance auditing experience favorable
Excel experience helpful

Responsibilities

Conduct audits upon claims as prescribed in the Medical Billing and Coding Compliance audit plan, especially upon changes made to claims by billers employed, contracted, or subcontracted by the Company
Conduct research to answer billing questions or concerns that arise while conducting audits
Document audit findings within the tool developed for such; discuss questions with the department’s Billing and Coding Compliance Consultant and/or the Department Leader
Suggest possible policies and procedures or educational materials to be developed, or possible changes to be made within the billing system or client’s electronic health record
Other duties as assigned

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