Compliance Clinician Analyst

Overview

Compliance Clinician Analyst

Position Highlights: 

• Shift Schedule: 40 hours per week, day shift
• Department: Physician Compliance 
• Location:  Atrium Health Wake Forest Baptist in Winston-Salem, NC

What You'll Do: Supports the Compliance and Integrity Department with the review of risk-based, individual clinician documentation, coding, and billing. May be asked to assist with data analysis to determine high risk coding.  Conducts the identified reviews and communicates the findings to the reviewed clinician. Tracks and analyzes individual clinician reviews trends. May aid in developing and delivering compliance and regulatory educational materials to individual clinicians.

• Participates in the execution of an annual compliance work plan; with focus on individual clinician (MD, PA, NP, CNM) reviews
• Assists in the analysis of trend coding data to identify high risk clinician billing.
• Conducts individual clinician compliance reviews by comparing documentation, coding, and billing data to regulatory guidance.
• Prepares customized reports to summarize the results of the individual clinician reviews.
• Works with other teammates on the Compliance team and Revenue Cycle to deliver feedback to clinicians on review findings based on the results of the clinicians' reviews.
• Works with leaders to perform additional reviews of clinician's activities – beyond documentation and coding - to identify potential issues with clinician activity. This may include analysis of the clinician’s workload and administrative duties.
• Works with leaders to track and follow-up with individual clinicians to ensure all corrective actions are complete. 
• Assist Compliance & Integrity – Reimbursement Auditing and Monitoring leaders with research related to regulatory requirements.
• Assists Compliance & Integrity – Reimbursement Auditing and Monitoring leaders with other projects as assigned.

What You'll Need:

• Bachelors Degree or equivalent knowledge in Health Care Administration, Medical Coding, Health Information Management or health related field
• CPC or CCS-P certification
• Typically requires 3+ years of experience in a health care environment with knowledge of health care regulatory requirements and medical coding and billing experience. 
• 3+ years surgery coding experience preferred.

The ideal candidate will also possess the following skills:

• Working knowledge of compliance related regulations such as coding, billing, documentation requirements, Local and National Coverage Determinations, National Comprehensive Coding Initiatives, Medicare/Medicaid billing regulations, HIPAA Privacy rule, etc. 
• Strong computer, problem-solving and analytical skills, including ability to perform data mining to identify aberrant patterns that may be indicative of compliance issues or trends.
• Highly motivated, team oriented, professional and trustworthy, with strong skills in personal diplomacy.
• Presentation and writing skills to prepare and organize media for delivery of reports and education to physicians, leadership and teammates.
• Demonstrated ability to handle sensitive communications with leadership, physicians, management and legal counsel.
• Strong organizational and time management skills.
• Proficiency in Microsoft Office Suite software.
• Demonstrated ability to prepare spreadsheets and presentation materials

PHYSICAL REQUIREMENTS AND WORKING CONDITIONS

• This position may require travel, therefore, will be exposed to weather and road conditions. 
• Operates all equipment necessary to perform the job.
• Exposed to a normal office environment.

DISCLAIMER

All responsibilities and requirements are subject to possible modification to reasonably accommodate individuals with disabilities.

This job description in no way states or implies that these are the only responsibilities to be performed by an employee occupying this job or position.  Employees must follow any other job-related instructions and perform any other job-related duties requested by their leaders.