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BJC Medical Group · 8 hours ago

Sr. Compliance Coordinator-Billing & Coding

United States

Full-time

Remote

Senior Level

$57K/yr - $93K/yr

5+ years exp

BJC Medical Group is a multi-specialty physician-led organization affiliated with top-ranked hospitals in the Midwest. The Senior Compliance Coordinator is responsible for conducting reviews of specialty provider documentation to ensure billing accuracy, developing educational opportunities for compliance with regulations, and collaborating with departments to provide necessary training.

Health CareHospitalMedical

Responsibilities

Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services identified as part of the review for specialty providers or up on request from management

Interacts with specialty providers regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation based on the review

Develops and/or presents educational training material to specialty providers and coders based on findings and trends identified as a result of the reviews; provides general education on coding and documentation rules and regulations, regulatory provisions, and third party payer requirements to new employees and providers to include Employee and Provider New Employee Orientation

Interacts with government agencies/contractors, management, employees and others, as necessary, to ensure an understanding of the organization’s compliance initiatives

Conducts and coordinates routinely scheduled reviews of BJCMG specialty providers' documentation involved with professional fee billing for accuracy of coding and physical presence; reviews consist of ambulatory E&M services and office procedures, as well as hospital admissions, subsequent visits, hospital procedures, and all other services performed by BJCMG specialty providers; reviews medical record documentation to identify under-coded and up-coded services, prepares reports of findings, and meets with providers to provide education and training on accurate coding practices and compliance issues; serves as subject matter expert related to specialty coding

Conducts focused reviews across the BJCMG enterprise based upon the Compliance Department's annual work plan and/or trends identified based upon internal reviews or requests from senior leadership; performs special projects as requested/assigned by management; monitors trends across the organization and develops education and training on accurate coding practices and compliance issues

Provides guidance and serves as mentor to fellow coordinators related to the audit process, coding, billing and compliance; identifies and notifies management educational opportunities and/or concerns as a result of serving as lead auditor

Support the HIPAA liaison by tracking and conducting employee investigations when requested