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Physician Compliance Analyst - Professional Compliance

Job ID: 6168
Location: Morrisville, NC
Facility/Division: Shared Services
Status: Full Time
Shift: Day Job

Did you know UNC Health has Ranked #2 Most Trusted Healthcare Brand in the U.S.? The UNC Health brand was ranked as the #4 healthcare brand in the United States overall and the #2 most trusted healthcare brand, just after Johns Hopkins and before Mass General. Join our One-Great-Team!

Job Description

Description

Become part of an inclusive organization with over 30,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:

Responsible for assisting Compliance management in compliance activities which could include reviewing internal processes, documents and reports, and ensuring compliance with internal and external regulatory framework. Serves as a resource to physicians, coders and reimbursement analysts across UNC Health.

Responsibilities:

  • Auditing and Monitoring - Stays current with changing regulations, policies, procedures, standards and coding guidelines. The individual effectively identifies and analyzes areas of weakness, research causes and formulate recommendations that enhance operations and compliance. Familiarizes self with area under review, and if necessary, visits department/facility to gain operational and process knowledge. Researches all relevant materials including but not limited to regulations, policies, procedures, and other standards such as CPT coding guidelines and CMS policies. Assists in preparing annual audit and work plan. Performs work outlined in work plan. Obtains and analyzes data. Identifies and evaluates the area under review, identifying and documenting areas of risk and vulnerability related to non-compliance. Assists in development of new policies and procedures and audit tools. Performs E/M and Procedural coding audits. Analyzes audit findings and reports/tracks results for one-on-one or group feedback. Provides one-on-one or group education. Performs billing audits and ensures correct coding and billing compliance. Assists with RAC audits and review of other outside requests as directed. Documents audit work and findings in accordance with department standards. During the audit and monitoring process, identifies and analyzes areas weaknesses, research causes, and formulate recommendations back to the appropriate department. Provides communication of audit findings to department leadership as directed by management. The auditor should be familiar with basic clinical documentation and charge capture methodologies.
  • Customer Service - Provides courtesy and friendly service. Develops productive working relationships with all levels of management, staff and providers. Identifies and seeks resolution to barriers. Demonstrates customer service qualities that instill confidence. Mentors others on how to provide the highest level of customer service. Effectively follows up and closes all issues assigned or identifies issues to management with recommendations on how to proceed. Conducts and/or facilitates meetings where information is shared with operational departments concerning new regulations, billing and other compliance activities or other standards. Assists with the development and delivery of appropriate compliance training and education across the UNC Health Care System. Serves as a resource to physicians, coders and reimbursement analysts. Responds to inquiries on how best to code, document and bill for that impact professional compliance. Communicates openly and effectively with team members and management.
  • Investigations - Investigates, questions, gathers data, integrates and interprets data with the intent to report information and provide an analysis and recommendation of findings. Familiarizes self with area under review. Researches and gathers all relevant materials including but not limited to regulations, policies, and procedures, coding guidelines, and CMS rules regulations. Conducts interviews understanding operational workflows in order to thoroughly assess compliance issues and risk. Performs data collection and analysis. Documents findings in accordance with department standards, communicates findings as directed by management and provides an analysis of findings with recommendations. Works with departmental leaders on corrective action plans.
  • Professional Development - Maintains current knowledge of CPT and ICD coding guidelines as well as CMS policy and regulations. Reads trade journals articles related to coding and compliance and shares knowledge with peers and customers.
  • Special Projects - Performs special projects as requested by management as needed or assigned.

Requirements:

  • Bachelor’s degree in Accounting, Business Administration, Health Administration, Nursing or related field (or equivalent combination of education, training and experience).
  • Coding certification (e.g., CPC, CCS-P) within eighteen (18) months from date of hire.
  • If a Bachelor's degree: No prior experience required.
  • If an Associate's degree: Four (4) years of relevant experience.
  • If a High School diploma or GED: Eight (8) years of relevant experience.
This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care. This is not a State employed position.
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Diversity Statement

The UNC Health System and the UNC School of Medicine are committed to valuing all people throughout our organization, regardless of background, lifestyle, and culture. A diverse and inclusive work environment for staff and culturally appropriate care for our patients, are essential to fulfilling our UNC Health vision of improving the health of all North Carolinians.

Equal Employment Opportunity

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