Audit & Billing Compliance Specialist
University of Arkansas for Medical Sciences
The Audit & Billing Compliance Specialist, under the general direction of the Compliance Audit Manager, audits coding and billing functions according to the audit plan schedule with the focus on Hospital billing according to the Center for Medicare and Medicaid Systems (CMS) laws and regulations. This position audits departmental systems and processes to ensure compliance with all Medicare/Medicaid laws and regulations, state regulations and hospital and institutional policies. This position must understand all Medicare and Medicaid billing rules and regulations.
The University of Arkansas for Medical Sciences (UAMS) has a unique combination of education, research, and clinical programs that encourages and supports teamwork and diversity. We champion being a collaborative health care organization, focused on improving the health, health care, and well-being of Arkansans.
- Conducts coding and billing audit functions according to the audit plan schedule with the focus on Hospital billing according to the Center for Medicare and Medicaid Systems (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 Compliance Officer’s review as well as dissemination to Hospital Administration and Department Managers.
- Keeps abreast of current trends, problems and activities relating to coding.
- Proficient in and keeps current with all coding policies and procedures and applicable federal and state regulations.
- Serves as a resource to various and assigned departments on current regulations issues.
- Serves as resource to: HIM for coding issues; Hospital Billing Services (HBS) for charge and billing issues; Physician Compliance for charge and billing issues that also relate to facility charging and billing; and to all Ancillary departments and clinical areas for charging and billing issues as well as regulatory concerns.
- Disseminates regulatory and compliance information to Ancillary departments and Clinic areas as necessary.
- Develops and presents educational in-service programs on new regulatory issues for all inpatient and outpatient coders.
- Performs specific audits outside the audit plan schedule as needed (OIG, MAC, RAC, MIC, 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.
- Collects and enters data into computer tracking programs for reporting purposes.
- Produces reports in an easily understood format and ensures the information is correct and accurate.
- Reviews audit results within Clinical Billing Compliance and with the affected clinical department(s).
- Participates in special projects as assigned by the Clinical Billing Compliance Officer and/or the Vice Chancellor for Institutional Compliance and other duties as assigned.
- Performs other duties as assigned.
Bachelors’ degree plus five (5) years of inpatient and outpatient coding/auditing experience OR High School diploma/GED plus nine (9) years of inpatient and outpatient coding/auditing experience required.
Knowledge, Skills & Abilities:
- Must have one of the following CURRENT 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 ability to make reasonable decisions based upon the information gathered.
- Ability to make independent audit decisions.
- Must have the ability to interpret regulatory information and deliver learned information to physicians and also explain the financial impact to the hospital.
- Responsible for the final outcome of implemented projects.
- Functions as one of the primary contacts for clinical and other UAMS departments concerning any developed project or internal audit.
- Degree in Health Information Management, Healthcare Administration or in a related field.
- Current Certified in Healthcare Compliance (CHC), Certified Documentation Improvement Practitioner (CDIP), or Certified Professional Medical Auditor (CPMA) certification.
- Knowledge in the areas of surgical, inpatient and/or interventional radiology coding.
UAMS is an Affirmative Action and Equal Opportunity Employer of individuals with disabilities and protected veterans and is committed to excellence. If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (501) 686-6432 and let us know the nature of your request. We will only respond to messages left that involve a request for a reasonable accommodation in the application process. We will accommodate the needs of any qualified candidate who requests a reasonable accommodation under the Americans with Disabilities Act (ADA).