RHIA Compliance Associate, II

Northwestern Memorial Healthcare•Chicago, IL

About The Position

The Compliance Associate II reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards. Responsibilities: This position has primary responsibility for auditing/reviewing provider documentation, coding, and billing to ensure that the documentation supports the CPT codes billed to government payors. Results of the provider audits/reviews are shared with the provider, so strong written and verbal communication skills are important. Strong coding understanding, professional coding certification is required. Professional coding experience is preferred. Responsible for answering inquiries related to professional documentation, coding, and billing regulatory requirements. Work with Senior/Manager/Director on more complex issues or investigations. Help manage all aspects of the Compliance Hotline and compliance issues received via e-mail and phone. Help ensure reported issues are appropriately received, evaluated, investigated, documented, and resolved. Respond to queries or allegations and triage issues to appropriate departments when necessary (i.e., Human Resources Compliance). Assist with maintaining a log/database of all issues received by the department through the compliance hotline, e-mails, phone calls, etc. Document all issues received, actions taken, and resolutions. Maintain a current understanding of regulatory trends and changes in compliance and regulatory guidelines that affect NMHC and its subsidiaries by monitoring various resources to assess regulatory changes and determine organizational impact. Coordinate investigations in response to incoming compliance related issues. Gather all relevant information for potential compliance issues, determine underlying causes, and relate information from different sources to draw logical conclusions. Coordinate non-coding and non-billing related audits, reviews and, when necessary, investigations (in conjunction with the Corporate Compliance Manager) in response to CMS, OIG, and/or other regulatory concerns that emerge throughout the year. Perform follow-up, audits, reviews, investigations, and validations. Assist with data analysis to determine root cause of reported or identified issues and determine level of escalation required. Assist with the development of compliance education and training materials. Assist departments in the development of corrective action plans for identified issues. Assist with the development of dashboards, written reports, or other deliverables to be presented to the department, VP Integrity, Senior Leadership, and/or the Audit Committee. Support and assist the Corporate Compliance Manager in identifying and assessing areas of compliance risk for NMHC Assist with the development and implementation of the departments annual Compliance Work Plan. Help develop and maintain compliance-related policies and procedures to ensure they are current and relevant. Assist with providing policy-related guidance to individuals and departments. Perform other duties assigned by the department Managers, Director, or VP, Integrity. AA/EOE.

Requirements

Bachelor's Degree
RHIA, CPC or similar credential
Demonstrated ability to work with various levels within the organization regarding confidential information and maintain sensitive data.
Strong interpersonal and communications skills required.
Ability to work collaboratively and communicate with others in a clear, concise, and professional manner on the telephone and in person, as well as demonstrate use of good written and verbal communication skills.
Knowledge and experience in using Word, Excel, PowerPoint, Access and similar Office programs.

Nice To Haves

Certified Healthcare Compliance (CHC) certification.
JD, MBA or similar degree.
Healthcare compliance experience.

Responsibilities

auditing/reviewing provider documentation, coding, and billing
answering inquiries related to professional documentation, coding, and billing regulatory requirements
Help manage all aspects of the Compliance Hotline and compliance issues received via e-mail and phone
Coordinate investigations in response to incoming compliance related issues
Coordinate non-coding and non-billing related audits, reviews and, when necessary, investigations
Assist with data analysis to determine root cause of reported or identified issues and determine level of escalation required.
Assist with the development of compliance education and training materials.
Assist departments in the development of corrective action plans for identified issues.
Assist with the development of dashboards, written reports, or other deliverables
Support and assist the Corporate Compliance Manager in identifying and assessing areas of compliance risk for NMHC
Assist with the development and implementation of the departments annual Compliance Work Plan.
Help develop and maintain compliance-related policies and procedures
Assist with providing policy-related guidance to individuals and departments.
Perform other duties assigned by the department Managers, Director, or VP, Integrity.