Compliance Manager - MUSC

Job Description SummaryManage Physician Coding and Billing compliance operations for assigned specialties, physicians and staff as established by the MUSC Physicians Compliance Plan and other organizations where MUSC Physicians provides complianc...

Job Description Summary

Manage Physician Coding and Billing compliance operations for assigned specialties, physicians and staff as established by the MUSC Physicians Compliance Plan and other organizations where MUSC Physicians provides compliance oversight via contract. Provide physician/provider and staff education and serve as a resource to the assigned departments on coding, billing and regulatory issues.

Entity

University Medical Associates (UMA) Only Employees and Financials

Worker Type

Employee

Worker Sub-Type​

Regular

Cost Center

CC002046 UMA CORP COMP Compliance CC

Pay Rate Type

Salary

Pay Grade

Health-27

Scheduled Weekly Hours

40

Work Shift

Job Description

Job Duties

40% AUDITING

· Complete monthly audits following UMA Auditing Policy and report findings to the individual audited, the Physician Liaison, Department Administrator and Chairman on a monthly basis.

· Perform risk-based audits, as needed to ensure compliance, based on bell curve information, OIG Work Plan issues, New Providers, Level III Providers, helpline calls or other criteria established by the CCPO, Senior Managers, Executive Compliance Committee or other party, as applicable.

· Assist the Senior Manager & Corporate Data Manager in developing methodology for audits and reports in order to present findings in a clear concise manner. Responsible for follow up audits to validate resolution of documentation issues and completion of corrective action plans.

· Research Coding and other regulatory issues for clinicians and care team members. Respond to concerns and allegations and work with CCPO or Sr. Managers to develop corrective action plans and follow up appropriate to the issues identified.

40% EDUCATION

· Assist in the development and deployment of educational/training materials and campaigns; communicates proactively extensively throughout the system to provide education on compliance matters including but not limited to coding guidelines, billing, documentation and reimbursement, Teaching Physician Regulations, and scope of practice.

· Responsible for providing and entering all education sessions into designated system per departmental instructions.

· Responsible for onboarding all new billing providers through one on one education within 30 days of start date.

20% OTHER JOB DUTIES

· Attend all Departmental Compliance meetings, department, division, clinic, or faculty meetings as requested.

· Works closely with clinicians and EMR technical staff in providing assistance and recommendations of EHR templates and other standardized documentation formats.

· Assist Sr. Compliance Managers and Chief Compliance and Privacy Officer on special projects and other duties assigned.

· Collaborate with Regulatory Manager to prepare assigned area summary for Annual Compliance Report.

· Responsible for monitoring and maintaining active and deferred charges within the work queue per departmental instructions.

Additional Job Description

Education and Work Experience

Bachelors and 3 years’ experience or Associates Degree with 5 years’ experience required. Internal candidates may be considered without a degree based on coding certification and relevant experience. Experience educating physician’s in-group or individual training sessions. Demonstrates solid technical knowledge, understanding of business concepts, regulatory rules and auditing procedures. Experience researching coding questions and providing documentation to support coding decisions. Extensive knowledge of ICD-9/10, CPT, HCPCS coding and Medical Terminology. Excellent communication and interpersonal skills. Must maintain credentials through education and stay current on regulatory trends and changes in the law. Knowledge of Microsoft Office Applications including Word, Excel and PowerPoint. Experience with and aptitude for using medical billing software.

Must be able to act independently in the furtherance of compliance objectives following Corporate Compliance Department established procedures and UMA policies. Must be able to identify and respond to escalated problems or questions in a timely fashion.

Licensures, Registrations, Certifications: CPC, CCS-P, RHIT or other Medical coding certification required.

Physical Requirements

Continuous requirements are to perform job functions while standing, walking and sitting. Ability to bend at the waist, kneel, climb stairs, reach in all directions, fully use both hands and legs, possess good finger dexterity, perform repetitive motions with hands/wrists/elbows and shoulders, reach in all directions. Maintain 20/40 vision corrected, see and recognize objects close at hand and at a distance, work in a latex safe environment and work indoors. Frequently lift and/or carry objects weighing 20 lbs. (+/-) unassisted. Lift from 36” to overhead 15 lbs. Infrequently work in dusty areas and confined/cramped spaces.

If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.

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