Healthcare System is currently seeking a Compliance Analyst for a 3 months contract opportunity in the San Diego area.
Requirements for the Compliance Analyst
Minimum of five (5) years of Inpatient coding and documentation auditing or active coding experience is required in the following coding systems: ICD-10-CM/PCS, DRG, CPT& HCPCs, and/or E/M CPT.
• Certification and high level of experience with coding in ICD-10-CM & ICD-10 PCS and CPT coding classification is required.
• AHIMA’s Certified Coding Specialist (CCS) or Certified Documentation Improvement Practitioner (CDIP) or AAPC Certified Inpatient Hospital/Facility (CIC) certification is required. Certified in Healthcare Compliance (CHC) is preferred. Please ensure that certifications are included on your application.
• AHIMA Approved ICD-10 CM/PCS Trainer preferred.
• Revenue Integrity Experience or Compliance Reimbursement Auditor Experience required.
• Outpatient and/or inpatient hospital coding experience is preferred in the following coding systems: ICD-10-CM/PCS, DRG, CPT& HCPCs, and/or E/M CPT.
• Must demonstrate excellent interpersonal, written and verbal communication presentation skills. Experience training physicians is preferred.
• Proficiency in using computer applications such as Microsoft Office Word and Excel programs is required, with preferred experience using 3M HDM, 3M 360, MD Audit, and Electronic Medical Record-Cerner and Epic.
• Knowledgeable of Centers for Medicare and Medicaid (CMS) or all applicable Federal and State statutes, regulations, and program guidelines related to inpatient and outpatient revenue integrity compliance guidelines.
Responsibilities of the Compliance Analyst
The Compliance Analyst has primary responsibility of daily oversight of all inpatient coding investigations, inquiries and correspondence as needed from key stakeholders. The analyst will also work on all inpatient coding related audits and reviews.
• Reviews the electronic health record to identify potential coding & billing compliance issues, based on ICD-10-CM/PCS coding rules, AHA Coding Clinics, Medicare conditions of payments (NCD/LCDs), Medicare Benefits and Claims Manual, and clinical knowledge from the most updated evidence-based journal/literature (clinical validation of diagnoses). The analyst must perform quality reviews on medical records to ensure compliance by validating assignment accuracy of MS-DRG, APR-DRG, or APC system, ICD-10-CM, ICD-10-PCS, & CPT-4 codes, SOI/ROM, and POA.
• Will continuously evaluate the quality of clinical documentation and monitor the appropriateness of queries with the overall goal of improving physician documentation through physician education and feedback and achieve accurate coding to support the optimal allowable reimbursement.
• Prepares and composes all findings and recommendations in a summary report and facilitates communication to the key stakeholders.
• Works under the supervision of the Corporate Compliance Audit & Clinical Manager and works in conjunction with System Management (HIM, CDI, Case Management, Quality, etc.) in support of developing Sharp Healthcare system’s standardized documentation, medical necessity, coding and billing policies and guidelines, and other educational materials and ensuring that these developed guidelines/policies complement the current official coding rules and guidelines, CMS’ beneficiary coverage rules and guidelines, and federal and state rules and regulations.
• The analyst will analyze and assess Sharp’s risks using Sharp’s Compliance Department billing and coding risk assessment data, MDAudit risk analyzer software, OIG Work plan, CMS, PEPPER Reports, RAC Denials, Industry Experts, etc. In addition, the analyst will analyze Sharp Healthcare’s hospital inpatient data and review patterns and trends and identify potential risk areas
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