Compliance audit program initiatives include but are not limited to physician and facility documentation audits, monitoring external audit request and other investigations specific to billing, coding and documentation practices. The audit activity performed each year is identified based on the then-current Office of Inspector General Work plan and compliance risk analyses. Customers include faculty, senior leadership, clinical and non-clinical staff, and students at the University of Chicago Medicine and Biological Sciences Division.
Conduct physician/provider and facility documentation audits.Ensures accuracy of data entered into the Internal Audit Database and prepares reports for audited physicians, department leadership, and organization leadership.Analyze audit data and provides summary feedback to clinic and billing staff, making recommendations for improvement.Determine charge corrections and refunds resulting from compliance audits.Provide input in the development and improvement of procedures used to complete the audit function.
Prepare and produce billing/coding/documentation communication for use as guidance documents, website content, newsletter content, education content, and other communication channels. Develop materials for use in education and communication derived from audit findings for feedback to physicians, department billing staff, and other compliance staff.
Conduct formal/informal education sessions for the purpose of educating and training faculty, non-physician providers, residents/fellows, coding/billing, and administrative personnel in CPT/HCPCS/ICD-10-CM coding, Health Information Management compliance, Centers for Medicare and Medicaid (CMS) Physicians At Teaching Hospitals (PATH) rules, and billing requirements.
Stay abreast of current trends related to healthcare compliance regulations.Perform routine review of fact sheets, frequently asked questions and other resources published by the Department of Health and Human Services including the Centers for Medicare and Medicaid Services, the Office of Civil Rights and/or the Office of the Inspector General as well as Medicare Administrative Contractors, the Illinois Department of Healthcare and Family Services (Medicaid) and industry newsletters/publications.
Serve as a liaison for questions, concerns, incidents, and complaints regarding compliance matters whether via in person, telephone, resource line, e-mail and United States mail.Actions may include responding directly to the inquiry, consulting with or interacting with other departments or coordinating with representatives or colleagues from other departments, forwarding the call to the appropriate Medical Center staff or another Compliance Office staff or management.Enter data into the Compliance Office tracking database.Based on types of questions/issues received, identify education/awareness opportunities and guidance topics.
Demonstrated capacity to work independently in an organized, detailed manner while maintaining a collaborative team environment is required.
Ability to think abstractly and concretely required.
Ability to develop reports, presentations, and spreadsheets required.
Strong computer skills including the ability to effectively use software applications such as Microsoft Word, Excel, Outlook, PowerPoint, Access and Internet Explorer is required.
Outstanding verbal and written communication skills are required.
Experience in handling complex organizational projects; and an excellent problem identification and solution skill to address difficult, complex issues is required.
Education, Experience or Certifications:
Bachelor's degree in health administration, health information management, nursing or other related field required.
Knowledge of state, federal, local, and payer-specific regulations and policies pertaining to documentation, coding, and billing is required.
Minimum of three years of experience in healthcare compliance, healthcare operations or billing, coding and/or documentation auditing in a health care organization is preferred.
Academic medical center and/or health care consulting experience preferred.
AHIMA or AAPC certification (RHIA, RHIT, CCS, and CPC) to demonstrate coding expertise is preferred.
Experience with GE Centricity Business, Centricity Enterprise and Epic preferred.
NOTE: When applying, all required documents MUST be uploaded under the Resume/CV section of the application
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