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Compliance Investigator - Anesthesiology The candidate will be responsible for monitoring/maintaining internal Department compliance function accessible to all faculty and staff for internal inquiries concerning billing practices and/or reports of non-compliance. Include assignment of case number, logging of complaints and investigation results and measures to allow follow-up while maintaining callerâ€™s anonymity. Will be responsible for investigating all inquiries concerning billing practices or reports of non- compliance reported directly to the compliance office or via the help line, or per request of the Department Leadership. Process may include establishing audit methodology, developing appropriate data-collection forms, consulting with general counsel, supervising the audit process, compiling and analyzing data/results and preparation of written reports including recommendation of corrective action. Presenting findings, as indicated, to key member of the compliance team, including compliance leader, Executive Director, Department Chair and Division Chiefs as appropriate. Performing Departmental internal risk assessment to identify possible compliance risk including, historical claims analysis, analysis of physician/division practice patterns as compared to national standards and Medicare utilization tables and assessment of software and electronic modules/programs /systems utilized in the billing process. Analyzing data to determine education and/or special audit needs. Reviewing current professional billing operations utilized by each clinical division, including evaluation of software program/programming in use and review of contracted third-party entities to evaluate/facilitate compliance. Acting as physician/provider advocate and intermediary with University compliance offices, third-party payers, medical professional organizations in relation to compliance-related issues. Monitoring federal and other payer publications for current and proposed changes in regulation affecting professional fee billing, taking proactive action as indicated. Monitoring/tracking audit activity by outside entities and contracted services of third-party entities, including consultative groups, related to professional fee billing and other compliance-related issues. Overseeing Department billing compliance education effort. Participating with Executive Director and Billing Director in strategic planning related to the overall direction of the billing education program, reviews and approves training materials, educational programs and publications related to billing and documentation practices produced by compliance education team. Working with each Division within the Department to evaluate training opportunities with documentation and billing compliance and helps implement training programs to keep in compliance. Must be a graduate of an accredited school of nursing with current RN licensure in the state of Missouri, and/or graduate of a Health Information Management program (RHIA/RHIT) or equivalent education/experience in health related field. Should have experience in health law or paralegal studies. Knowledge of HCFA documentation and billing regulations is required. Should have experience in medical record review for documentation and/or utilization review or continuous quality improvement preferred, diverse clinical background. Knowledge of ICD-9, CPT coding and PC spreadsheets is required. Must have experience with IDX billing systems. Interactive communication skills with the ability to speak in front of large and small groups is needed.
Job ID: 39120.
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