Compliance Coordinator Job Opening

This position will audit compliance and coding standards and policies to ensure the University of Iowa Practice Plan (UIPP) practice and University of Iowa Healthcare receives full and accurate reimbursement for services that comply with coding and payment rules and regulations. Analyze complex reports, and develop initiatives that improve compliance and reduce risks to the institution. Develop and present educational courses related to compliant coding, billing and documentation.

• Perform preliminary investigation and analysis, including basic comparison of practice to regulations. Identify and recommend remediation procedures for both basic and complex issues. Implement recommendations as directed. Review and validate data/content of reports for accuracy.
• Summarize and present JOC audit/review findings to coders, billers, administrators, physicians and other hospital staff.
• Assist with RAC (Recovery Audit Contractor) and other payer auditing and tracking. Review coding and billing of audited records. Write appeals. Summarize and present findings to coders, administrators, physicians and other hospital staff.
• Audit inpatient and outpatient hospital medical records for proper coding and accurate documentation to ensure compliance with regulatory billing and coding regulations.
• Review facility-side and physician-side claim edits and reconcile for accuracy and compliance.
• Audit medical record documentation to identify missed professional billing opportunities and to ensure the professional services billed comply with CPT/HCPCS guidelines and third party payors’ (Medicare, Medicaid, Wellmark, etc) billing regulations, compliance program standards, and documentation requirements.
• Audit and analyze third party payor reimbursement to ensure proper remuneration.
• Audit insurance appeals and denial reports.
• Audit billing and charge documents to ensure charges are appropriate and consistent with Medicare's Local and National Coverage Decisions for appropriateness and completeness¸ assessing University of Iowa Healthcare’s compliance and reporting as necessary.

• Respond to basic and complex inquiries where interpretation may be required. Identify risk areas and gaps between practice and policy/regulations. Identify and recommend education, best practices, and issues to be audited. Monitor developments in regulations and work with affected units to develop response during comment period. Conduct basic research into policies and practices.
• Advise and educate physicians (resident and staff) and other professionals who bill third party payors on resolution actions when the recommended-billed service is not supported in the medical record and/or not consistent with CPT and third party payor guidelines.
• Provide timely leadership to faculty and departments; identify areas of non-compliance and facilitate determination/development of recommendations to University of Iowa Hospitals and Clinics and University of Iowa Physicians for programs to ensure compliance with all regulations.

• Coordinate specific aspects of external review and internal processes. Analyze and prepare data/reports. Support other compliance staff as directed.

• Audit and analyze reports, and develop/implement corrective measures related to documentation issues, coding patterns, physician productivity, reimbursement trends, etc.
• Review, assess and monitor changing regulations, assessing impact on operations and share information with department billing staff, physicians and administrators.
• Perform other functions as directed under the Joint Office for Compliance such as quality data abstraction, special audits and data submission and abstraction such as GPRO/ACO reporting.
  

• Assess effectiveness of policy/procedure. Develop policy/procedure as assigned.

• Review, write and amend policies and procedures related to coding guidelines, adhering to official and regulatory guidelines.
• Monitor and review on a continuing basis departmental and institutional policies and procedures related to billing and coding compliance, and recommend changes as needed.

• Prepare and deliver basic and complex content that enhances knowledge of and adherence to internal and external standards and regulations. The educational responsibilities of this position are approximately 50%.

• Develop and present educational sessions on topics including ICD-9-CM/ICD-10-CM/PCS coding, CPT/HPCS coding, teaching guidelines and other courses of interest to coding, federal and state regulations and billing. Present topics of interest at monthly coding meetings.
• Develop, implement, evaluate, and recommend educational programs on coding and billing issues resulting from auditing. Design necessary course materials, including evaluation form.
• Develop and participate in orientation and continuing education sessions for physicians, residents and staff about billing procedures and changes in documentation requirements, coding and other pertinent reimbursement issues. This may involve presentations at faculty or staff meetings, individual counseling or written memoranda.

• Provide direction, assignments, feedback, coaching and counseling to assure outcomes are achieved.

• Serve as a liaison for the Joint Office for Compliance to coding specialists, clinical department administrators, while maintaining effective working relationships with faculty, staff, students and the public.
• Participate in the development and implementation of quality improvement initiatives such as Pay for Performance, Severity-Adjusted DRG System, and ICD-10.