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COMPLIANCE PROGRAM SPECIALIST-PROF SERVICES

Bozeman Health
Bozeman

Job Description

The Compliance Specialist-Professional Services at the direction of the Director of Compliance, will assist and support the effectiveness of the Compliance Programs for the Bozeman Health( System) by maintaining and assisting with the development of Compliance Program documents. Assess and support the System Compliance Program Effectiveness. Facilitate the development of and conduct education & training for the System Compliance Program. Conduct data analytics and utilize the results to develop the Internal Auditing & Monitoring Plan for the System. Conducts audits in accordance with the System's Internal Auditing & Monitoring Plan. Summarize and communicate audit findings to individuals and groups on multiple levels, both internal and external. Develop educational resources and conduct education for the System to minimize errors and reduce exposure to fraud and abuse. Works closely with the Revenue Cycle Department, Healthcare Providers, and Clinic Managers.

REQUIREMENTS

EDUCATION

Required:

Bachelors degree and/or Associates degree in a Health Information Management (HIM) program

Preferred:

LICENSURE and CERTIFICATION

Required:

Certification as a Registered Health Information Technician(RHIT) or Registered Health Information Administrator (RHIA),

Preferred:

HIPAA Compliance Certification, Certified Coding Associate (CCS), Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Coding Specialist (CCS-P), or Certified Health Data Analyst (CHDA),

EXPERIENCE

Required:

Minimum 7-10 years of healthcare experience serving as a critical link bewtween care providers, coders, billers, payers, and patients to assist with minimizing errors and reducing exposure to fraud and abuse.
Possess in-depth knowledge of the CPT coding system and ICD-10-CM and HCPCs Level II coding system. Expert in health information documentation and data integrity.
Has comprehensive knowledge of medical, administrative, and information systems that employ patient data in decision-making and everyday operations.
Past experience in researching coding/ billing questions and has developed educational resources for stakeholders to utilize to minimize errors and reduce exposure to fraud and abuse.
Adheres to Bozeman Health's Core Values.

Preferred:

10-15 years experience working in a physician practice, hospital, or health system

ESSENTIAL FUNCTIONS

40% Time Spent -
Monitors compliance efforts identified in the System's Internal Auditing & Monitoring Plan with a specific focus on professional level documentation, coding to include evaluation and management coding (professional services).
Develops auditing and monitoring tools that will support audits and the monitoring of risk areas. Conduct audits, summarizes, and reports audit findings to appropriate stakeholders and assist with the collection of data uitilized for compliance efforts.

10% Time Spent -
Manage & Maintain Compliance Program documents, i.e. Retention/Destruction of Audit Log, Compliance Page on MIND, Compliance 360 Documentation of Research & Response

15% Time Spent -
Support and assist the System Director of Compliance with the development of compliance program documents, participate in the review of compliance program effectiveness and develop documents that support the effectiveness.
Review, identify and develop education & training needs or tools to support or improve ongoing compliance for the System.
Participate in the development of the Internal Auditing & Monitoring Plan by identifying current risk areas identified by the OIG and past historical exposure and as directed by the System Director of Compliance

15% Time Spent -
Manage, analyze, interpret, and transform data into accurate, consistent, and timely information and communicate findings to individuals and groups at multiple levels, both internal and external

10% Time Spent -
Maintain knowledge of State and Federal Regulations including but not limited to: Medicare Conditions of Participation, Medicare Billing and Reimbursement regulations, HIPAA privacy/security rules, and understanding the purpose of audits, coding knowledge, Medicaid, other government programs and agencies with healthcare industry oversight.

10% Time Spent -
Conduct research and summarize research results regarding compliance issues as directed by the System Director of Compliance.

Employment Type

Full Time

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