Audit and Billing Compliance Specialist

University of Arkansas for Medical Sciences

The Inpatient Audit & Billing Compliance Specialist works under the general direction of the Clinical Billing Compliance Director and reviews medical records and billing system programs to determine coding and billing accuracy and to ensure that all federal and state guidelines for coding and billing are followed. Conducts inpatient coding and billing audit functions according to the audit plan schedule with the focus on hospital billing according to the Centers for Medicare and Medicaid Services (CMS) laws and regulations. Provides education and training to coding staff as well as ancillary department staff.

The University of Arkansas is an equal opportunity institution. The University does not discriminate in its education programs or activities (including in admission and employment) on the basis of any category or status protected by law, including age, race, color, national origin, disability, religion, protected veteran status, military service, genetic information, sex, sexual preference, or pregnancy. Questions or concerns about the application of Title IX, which prohibits discrimination on the basis of sex, may be sent to the University’s Title IX Coordinator and to the U.S. Department of Education Office for Civil Rights.

FACILITIES CODING AUDITS

• Conducts inpatient and outpatient coding & billing audit/monitoring functions according to the audit plan schedule, with a focus on hospital billing according to the Centers for Medicare and Medicaid Services (CMS) laws and regulations.
• Audits departmental systems and processes to ensure that they comply with state and federal laws and regulations.
• Provides audit results to the affected areas and educates staff regarding errors. Prepares detailed audit reports for the Clinical Billing Compliance Director and Associate Vice Chancellor review as well as dissemination to Hospital Administration, Revenue Cycle and Department Managers as appropriate. This position works very independently and must have good decision-making skills.

TRAINING AND DEVELOPMENT

• Develops and presents educational in-service programs on new regulatory issues for all inpatient and outpatient coders.

REQUIRED PROFESSIONAL PROFICIENCIES

• Keeps abreast of current trends, problems, and activities relating to coding.
• Proficient and keeps current with all COM/UAMS coding and billing policies and procedures and applicable federal and state regulations.
• Serves as a resource to assigned departments on current regulations, coding issues, charge and billing issues, facility charging and billing as well as regulatory concerns.
• Disseminates regulatory and compliance information to Ancillary departments and Clinic areas as necessary.

PERFORM EXTERNAL AGENCY and SPECIAL AUDITS

• Performs specific audits outside the audit plan schedule as needed (to include, but not limited to, Office of Inspector General (OIG) audits, Medicare Administrative Contractor (MAC) audits, Recovery Audit Contractor (RAC) audits, Medicaid Integrity Contractor (MIC) audits, etc.).
• Reviews RAC audits for any Diagnosis-Related Group (DRG) issues as needed.
• Writes RAC appeal letters for DRG changes.
• Communicates with regulatory agencies (Medicaid, Novitas Solutions, etc.) as necessary for clarification of regulations or for assistance with audit issues or coding issues as needed.

DIVISION SUPPORT/COMMITMENT TO INSTITUTIONAL COMPLIANCE

• Participates in special projects as assigned by the Senior Director of Clinical Billing Compliance and/or the Associate Vice Chancellor for Institutional Compliance/Chief Compliance Officer and other duties as assigned.

Minimum Qualifications:

• Baccalaureate degree plus 3 years’ experience in inpatient and outpatient coding/auditing functions OR
• High School diploma plus 7 years’ experience in inpatient and outpatient coding/auditing functions.
• Must have one of the following CURRENT coding certifications: Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC), Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT).
• Must have demonstrated ability to present information verbally and have strong written communication skills with attention to detail.
• Must have the ability to make reasonable decisions based upon the information gathered, interpret regulatory information, and deliver learned information to physicians. and explain the financial impact to the hospital.

Preferred Qualifications:

A degree in Health Information Management, Healthcare Administration, or a related field

Education Qualifications:

• Baccalaureate degree plus 3 years’ experience in inpatient and outpatient coding/auditing functions OR
• High School diploma plus 7 years’ experience in inpatient and outpatient coding/auditing functions.
• Must have one of the following CURRENT coding certifications: Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC), Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT).

Compensation/Benefits:

Commensurate with education and experience.

Instructions for Resume Submission

Please attach your resume to the online application and list of related certifications.

Apply Online: https://uasys.wd5.myworkdayjobs.com/UAMS_All_Careers/job/Little-Rock/Audit-and-Billing-Compliance-Specialist_R0088165