Compliance Reimbursement Consultant – Atrium Health Wake Forest Baptist FT Day REMOTE
Job ID:
R225958
Shift:
1st
Full/Part Time:
Full_time
Pay Range:
$41.10 – $61.65
Location:
Remote, WI
Benefits Eligible:
Yes
Hours Per Week:
40
Our Commitment to You:
Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:
Compensation
- Base compensation within the position’s pay range based on factors such as qualifications, skills, relevant experience, and/or training
- Premium pay such as shift, on call, and more based on a teammate’s job
- Incentive pay for select positions
- Opportunity for annual increases based on performance
Benefits and more
- Paid Time Off programs
- Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
- Flexible Spending Accounts for eligible health care and dependent care expenses
- Family benefits such as adoption assistance and paid parental leave
- Defined contribution retirement plans with employer match and other financial wellness programs
- Educational Assistance Program
Schedule Details/Additional Information:
Medical Group Support Job Description:
- Assist with hotline triage and response for Medical Group/Clinic compliance questions and concerns
- Navigation/connection to other support departments and collaboration within compliance team, as needed
- Assist with risk assessment process and remediation for Medical Group risks
- Assist with physician compensation analysis, as assigned
- Research of regulatory topics related to physician/professional services, reimbursement, and program requirements
- Prepare and present compliance reviews, regulatory, and educational information to audiences across the organization
- Assist with monthly review of regulatory updates at federal and state levels
- Assist with preparation of content and presentation of materials for leader rounding and ambassador meetings
Experience/Skills Helpful:
- Medical Group/Clinic operations knowledge
- Professional Coding and/or billing knowledge/coding certification
- Familiarity with federal and state payer and/or regulatory guidance for physician or professional services
- Experience or comfort presenting prepared information via Teams
- Broad organizational knowledge and strong critical thinking skills
- Strong intellectual curiosity and affinity to learn and work in new areas
Major Responsibilities:
- Contributes to the development (through risk assessment), execution, and updating of the Compliance & Integrity Department’s annual compliance work plan, with focus on reviews impacting health system reimbursement
- Conducts and/or leads Enterprise compliance reviews and investigations impacting hospital and physician reimbursement., Participates in other compliance activities including design and documentation of the review/investigatory methodology.
- Performs data collection for proactive reviews and investigations of potential compliance issues. Assists in other compliance activities such as risk assessments, surveys, etc. Participates in the use of analytical software and statistical sampling techniques to identify compliance concerns.
- Collaborates with various departments to obtain information needed in conducting risk-based reimbursement reviews, and investigations. Uses the collected information to scope the reviews and investigations, develop statistical sampling methodologies, and conduct the reviews.
- Prepares reports of reviews and investigations and delivers the results to Operational Leaders.
- Facilitates and/or assists in the design of corrective action in departments throughout the Enterprise to promote compliant practices and processes.
- Performs tracking and follow-up to ensure all identified corrective actions are complete.
- Preparing documentation and communication to report compliance repayments to governmental agencies and other payors.
- Assists in creating education and communication material for internal and external audiences on compliance issues.
- Partners with leadership to establish ongoing compliance monitoring and reporting. Performs follow-up activities to ensure corrective action plans have been implemented and maintained.
- Prepares routine reports for Operational leaders and Compliance Committees regarding the compliance review activities and actions taken and creates reports for regulatory agencies as directed.
- Reviews and opines on clinical services involving new services and/or external vendors.
- Performs research related to regulatory requirements involving health system reimbursement. Prepares regulatory guidance documents to share with other members of the Compliance & Integrity Department and Operational Leaders.
- Completes special compliance related projects as needed.
Licensure, Registration, and/or Certification Required:
- CCS, CCS-P CPC, CHC or CRCR certification required
Education Required:
- Bachelors Degree or equivalent knowledge in Health Care Administration, Medical Coding, Health Information Management or health related field.
Experience Required:
- Typically requires 5+ years of experience in a health care environment with knowledge of health care regulatory requirements and medical coding and billing experience.
Knowledge, Skills & Abilities Required:
- Working knowledge of compliance related regulations such as coding, billing, documentation requirements, Local and National Coverage Determinations, National Comprehensive Coding Initiatives, Medicare/Medicaid billing regulations, HIPAA Privacy rule, etc.
- Strong computer, problem-solving and analytical skills, including ability to perform data mining to identify aberrant patterns that may be indicative of compliance issues or trends.
- Highly motivated, team oriented, professional, and trustworthy, with strong skills in personal diplomacy.
- Presentation and writing skills to prepare and organize media for delivery of reports and education to physicians, leadership, and teammates.
- Demonstrated ability to handle sensitive communications with leadership, physicians, management, and legal counsel.
- Strong organizational and time management skills.
- Proficiency in Microsoft Office Suite software. Demonstrated ability to prepare spreadsheets and presentation materials.
Physical Requirements and Working Conditions:
- This position may require travel, therefore, will be exposed to weather and road conditions.
- Operates all equipment necessary to perform the job.
- Exposed to a normal office environment.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
Aurora Health Care is the largest health system in Wisconsin and a national leader in clinical innovation, health outcomes, consumer experience and value-based care. The state’s largest private employer, the system serves patients across 17 hospitals, more than 70 pharmacies and more than 150 sites of care. Aurora Health Care, in addition to Advocate Health Care in Illinois and Atrium Health in the Carolinas, Georgia and Alabama, is now part of Advocate Health, the third-largest nonprofit, integrated health system in the United States. Committed to providing equitable care for all, Advocate Health provides nearly $5 billion in annual community benefits.
