MUSCP – Compliance Reviewer
Medical University of South Carolina – Physicians
Hours per week: 40
Scheduled Work Hours/Shift: Monday – Friday 8:00am – 5:00pm
Pay Basis/FLSA: Salary / Exempt
Review compliance operations for assigned specialties, physicians and staff as established by the UMA Executive Compliance Committee. Serve as a resource to the assigned departments on coding, billing and regulatory issues.
Minimum Training and Education:
- High School diploma and 1-2 years of coding experience.
- Experience researching coding questions and providing documentation to support coding decisions Intermediate knowledge of ICD-9/10, CPT, HCPS coding and Medical Terminology.
- Excellent communication and interpersonal skills.
- Must maintain credentials through education and stay current on regulatory trends and changes in the law.
- Knowledge of Microsoft Office Applications including Word, Excel and PowerPoint.
- Experience with and aptitude for using medical billing software
Required Licensure, Certifications, Registrations:
- CPC, CPC-A, CCS-P, RHIT or other Medical coding certification required.
- For internal candidates only: We will consider candidates who have the skills and experience necessary to perform the job but do not have a CPC certification. These candidates must be willing to attain their CPC credential within 12 months of hire.
Degree of Supervision:
- Will work under the supervision of Senior Compliance Manager on assigned task.
- Must be able to work with minimum supervision on audits and to perform research on assigned issues.
- Must be able to identify training opportunities or areas requiring further research in order to bring these to the attention of the Compliance Manager.
- Will work under the supervision of the Senior Compliance Manager to create educational presentations and spreadsheets.
Job Duties and Responsibilities:
- Instruct and communicate to staff and physicians in proper coding guidelines, insurance carrier regulations, medical records and documentation requirements via departmental policies, memos and faculty meetings.
- Complete monthly audits following UMA Auditing Policy and communicate to key stakeholders regarding audit findings on a monthly basis. Perform special audits as needed to ensure compliance, based on bell curve information, OIG Work Plan issues, New Providers, Level III Providers, helpline calls or other criteria established by the Director, Executive Compliance Committee or Senior Compliance Manager.
- Provide detailed findings for educational opportunities in collaboration with assigned Compliance Manager
- Responsible for entering all audit information into UMA audit database accurately and according to monthly auditing schedule. Prepare reports for CBO to use to make adjustments per findings as necessary.
- Research coding, and other billing regulatory issues for faculty and staff in designated divisions, as well as for CRC and CBO contacts. Respond to concerns and allegations and work with Senior Compliance Manager to develop corrective action plans and follow up appropriate to the issues identified.
- Attend all meetings as directed by the Director or Senior Compliance Manager.
- Stay up to date on insurance guidelines and regulations through training and utilization of monthly newsletters and proactively educate providers and departmental staff regarding changes and issues affecting their specialty
- Performs other duties as assigned
- Continuous requirements are to perform job functions while standing, walking and sitting.
- Ability to bend at the waist, kneel, climb stairs, reach in all directions, fully use both hands and legs, possess good finger dexterity, perform repetitive motions with hands/wrists/elbows and shoulders, reach in all directions.
- Maintain 20/40 vision corrected, see and recognize objects close at hand and at a distance, work in a latex safe environment and work indoors.
- Frequently lift and/or carry objects weighing 20 lbs (+/-) unassisted. Lift from 36” to overhead 15 lbs. Infrequently work in dusty areas and confined/cramped spaces.
CPC, CPC-A, CCS-P, RHIT or other Medical coding certification required.
High School diploma and 1-2 years of coding experience.