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Augusta University · 3 months ago

DCG Billing Compliance Analyst

Augusta, GA

Full-time

Onsite

Mid, Senior Level

4+ years exp

Augusta University is Georgia's innovation center for education and health care, and they are seeking a DCG Billing Compliance Analyst to conduct internal billing audits and compliance investigations. This role involves producing audit reports, monitoring compliance, and providing training on billing and documentation policies.

Higher Education

Responsibilities

Performance of interim, and annual billing, documentation audits across multiple dental and medical specialties and programs for faculty, resident and student providers to identify potential compliance risks and assist with the development of corrective action plans

Monitor and analyze missing charge and procedure reports, communicate and coordinate with Program Directors on chart deficiencies, verify chart updates

Monitor and analyze corrective action plans to ensure DCG billing operations are aligned with DCG and Augusta University policies and adhere to contractual (commercial insurance), federal, state, local, regulatory documentation, coding and billing requirements

Provide periodic training to providers and employees on DCG and Augusta University compliance policies to include but not limited to contractual (commercial insurance); regulatory (e.g. False Claims Act, Stark Laws, Anti-Kickback Statutes) for billing, coding, and documentation referrals, and contracts

Prepare and submit annual and interim audit reports

Maintain detailed records of audit and monitoring activities for reporting to the Director of Regulatory Compliance

Analyze audit data to identify trends to aid in developing recommendations for training or corrective action plans

Conduct investigations of potential compliance violations using the University System of Georgia (USG) investigation guidance

Perform root cause analyses

Prepare reports in accordance with USG and AU protocols and standards

Maintain current and applicable knowledge of payor billing rules, federal and state documentation and billing laws and industry standards, CDT, CPT, ICD-10-CM, and HCPCS coding guidance through attendance of conferences, webinars, and other professional development activities

Perform all other job-related duties as assigned

Qualification

Certified Professional CoderHealthcare ComplianceBillingCoding KnowledgeAudit ReportingProject ManagementConfidentialityProblem SolvingEffective Communication

Required

Bachelor's degree from an accredited college or university in healthcare or business-related field with two years of clinical or administrative experience in dental or medical healthcare environment as a certified coder with certification form the American Academy of Professional Coders (AAPC), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Dental Assisting National Board (DANB) or American Health Information Management Association (AHIMA). Third-party and federal payor insurance background/experience and knowledge of coding, billing, documentation, and reimbursement criteria

Associate's degree from an accredited college or university in healthcare or business-related field with four years of clinical or administrative experience in dental or medical healthcare environment as a certified coder with certification form the American Academy of Professional Coders (AAPC), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Dental Assisting National Board (DANB) or American Health Information Management Association (AHIMA). Third-party and federal payor insurance background/experience and knowledge of coding, billing, documentation, and reimbursement criteria

Certified coder with certification form the American Academy of Professional Coders (AAPC), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Dental Assisting National Board (DANB) or American Health Information Management Association (AHIMA)

Preferred

Master's degree from an accredited college or university in healthcare or business-related field

Advanced knowledge of the Center for Medicare and Medicaid Services and other third-party payor coding, billing, and documentation criteria

Four or more years of clinical or administrative experience in dental or medical healthcare auditing billing, coding, and documentation for professional claims across multiple specialties

Five or more years of experience in compliance auditing and monitoring roles

Certified in Healthcare Compliance (CHC)

Knowledge of audit sampling methodologies

Benefits

Health insurance

Dental insurance

Life insurance

Teachers Retirement System (or Optional Retirement Plan)

Earned vacation time

Sick leave

13 paid holidays

Tuition Assistance Program

Company

Augusta University

Glassdoor3.6

Augusta University offers opportunities #LikeNoOther through groundbreaking research, patient-centered clinical expertise and forward-thinking educational programs from three campuses in the beautiful Southern city of Augusta, Georgia, and satellite locations across the state.

Founded in 1828

Augusta, ga, US

5001-10000 employees