The Compliance Coding Audit Manager (CCAM) will play a lead role in identifying potential compliance coding risk areas (through routine risk assessments and other methods) and work together with the Chief Audit, Compliance & Privacy Officer to develop an annual risk-based coding compliance work plan. The CCAM will provide day-to-day oversight for ongoing compliance and coding auditing activities. Must have a working knowledge of health care documentation, coding and billing requirements and federal and state health care regulatory requirements.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:
• Develops an annual Compliance Coding & Privacy work plan in conjunction with the Privacy Director.
• Initiates the compliance audit planning process; for each audit assesses relevant risks with the assigned compliance auditor and oversees the development of the compliance audit approach.
• Provides day-to-day guidance and support of the compliance auditing staff, recognizing the need to modify programs/procedures based on initial assessments and testing.
• Sets the agenda for and leads compliance audit exit conferences. Provides clear direction and priorities, clarifies roles and responsibilities and facilitates effective communication throughout the project.
• Reviews reports prepared by the compliance auditors. Provides final draft reports to the Chief Audit, Compliance & Privacy Officer as appropriate, based on the identified risks and outcomes.
Supervises the activities of the Coding and Billing Compliance Audit staff and recommends the hiring, firing, promoting, demoting, performance evaluations, transfers and/or disciplining of employees, as well as other personnel actions according to University policies and procedures. Assigns individual staff members to specific physician audits.
Has specific responsibility for conducting focused or special OIG Workplan audits. Provides overflow assistance to Compliance Coding Auditors responsible for internal audits in specific physician areas related to medical documentation supporting claims billed to third parties to ensure billing is completed in accordance with appropriate third party regulations and/or standards.
EDUCATION and/or EXPERIENCE:
• 5-8 years related work experience required and 2-3 years supervisory/management experience required.
• Related work experience must include a minimum of 5 years in healthcare audit experience and/or compliance auditing.
• Working knowledge of healthcare documentation, coding and billing requirements.
• Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases. Experience with MDAudit a plus.
• Develops and coordinates an educational training program regarding elements of the Coding and Billing Compliance Program; such as appropriate documentation and accurate coding to all appropriate personnel, including coding staff, physicians, billing personnel and ancillary documents.
• Maintains attendance rosters and documentation (agendas, handouts, etc.) for Coding and Billing training programs.
• Serves as a resource for department managers, staff physicians and administration to obtain information or clarification on accurate and ethical coding and documentation standards, guidelines and regulatory requirements.
• Monitors adherence to the Coding and Billing Compliance Program.
• Revises the Coding and Billing Compliance Program in response to changing organizational needs and/or new or revised regulations, policies and guidelines.
• Serves on the SOM Compliance Committee.
• Recommends revisions to the SOM Compliance Program to improve its effectiveness.
• Ensures that coding consultants and other contracted entities (i.e., outsourced coding personnel) understand and agree to adhere to the organizations Coding & Billing Compliance Program.
• Occasional travel required.
• Certification as a CPC, CCS-P, Specialty certifications a plus (CEMC, CPMA)
• Written Communications: Ability to communicate complex information in English effectively in writing to all levels of staff, management and external customers across functional areas.
• Oral Communications: Ability to verbally communicate complex concepts in English and address sensitive situations, resolve conflicts, negotiate, motivate and persuade others.
• Knowledge: Ability to demonstrate broad and comprehensive knowledge of theories, concepts, practices and policies with the ability to use them in complex and/or unprecedented situations across multiple functional areas.
• Team Work: Ability to lead collaborative teams for larger projects or groups both internal and external to the University and across functional areas.
• Customer Service: Ability to lead operational initiatives to meet or exceed customer service standards and expectations in assigned unit(s) and/or across multiple areas in a timely and respectful manner.
• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
•The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Internal Number: 493822
About Rowan University
A leading public institution, Rowan University combines liberal education with professional preparation from the baccalaureate through the doctorate. Rowan provides a collaborative, learning-centered environment in which highly qualified and diverse faculty, staff, and students integrate teaching, research, scholarship, creative activity, and community service. Through intellectual, social and cultural contributions, the University enriches the lives of those in the campus community and surrounding region.