Job Description

Our team members are the heart of what makes us better.

At Hackensack Meridian Health we help our patients live better, healthier lives and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. Its also about how we support one another and how we show up for our community.

Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

The Compliance Specialist assures on-going compliance and implements an effective compliance program under the direction of the Regional Compliance Officer. Proactively assesses changes in the regulatory environment; researches, investigates, reviews and responds to issues related to accreditation, documentation, coding, billing and licensure. Coordinates and participates in the record/claims review process, provides documentation and compliance education sessions to physicians and other staff. I The Compliance Specialist may assist the Regional Compliance Officer(s) with other aspects/projects/tasks/reviews of the Compliance Program to assure compliance with licensure, accreditation and other applicable state and federal regulations.

A day in the life of a Compliance Specialist at Hackensack Meridian Health includes:

• Investigates, responds to and communicates information regarding, documentation, coding, billing compliance and reimbursement.
  • Facilitates the review of timely, accurate and complete documentation.
  • Assists in identifying appropriate documentation requirements for specialized services.
  • Support, provide analysis for and advise senior leadership regarding coding and documentation impact on accreditation, revenue and reimbursement issues.
  • Analyze and trend coding issues/questions from both a compliance and regulatory perspective.
  • Works with Health Information Staff to assure appropriate documentation standards in support of ethical coding and data abstraction for public reporting.
  • Ensures the appropriate dissemination and communication of regulation, policy and guideline changes to affected personnel.
• Develops training materials and provides compliance education to leadership, physicians and other team members as required.
  • Provide accurate and up to date information on regulatory and reimbursement requirements.
  • Provide documentation and coding expertise for all compliance and reimbursement issues.
  • Prepare reports and graphics for presentation.
  • Maintain attendance lists for all presentations and log of issues raised and identified for future research and response.
  • Develop educational materials related to documentation, compliance and reimbursement, for physicians and other staff.
  • Develops and maintains policies as required in conjunction with the Regional Compliance Officer (s).
• Provides input into the development of the annual Audit & Compliance Work Plan, coordinatesand performs compliance reviews/audits for outpatient and inpatient services.
  • Uses analytics and evaluates the regulatory environment in support of the Audit & Compliance Work Plan development.
  • Conducts audits and investigations as part of the Audit & Compliance work plan. May conduct reviews under the direction of counsel as required.
  • In accordance with goals established by the Regional Compliance Officer, complete reviews within established timeframes, analyze and present results and prepare formal reports with findings and recommendations.
  • Consult with physicians and other clinical staff for clarification of clinical data when ambiguous information is encountered.
  • Facilitate and improve staff understanding of regulatory and payer requirements by providing feedback related to documentation information.
• Participate in the revenue cycle process to ensure both compliance and the maximization of appropriate departmental reimbursement.
  • Participate in meetings with coding, billing, abstraction and reimbursement staff to review claims, evaluate accuracy and develop appropriate strategies for addressing errors, as needed.
  • Review requests from insurers and patient families for copies of patient medical charts and/or changes in codes/fees.
  • Participate in the development and implementation of systems/procedures related to rejection and follow-up strategies.

Education, Knowledge, Skills and Abilities Required:

• 4-year bachelor's degree in Business Management, Healthcare Administration or related law/health field or equivalent.
• Computer proficiency and demonstrated presentation skills required.

Education, Knowledge, Skills and Abilities Preferred:

• Master's degree in Business Management or related law/health field.
• 3-5 years in a healthcare compliance role, or equivalent.
• Familiarity with TJC, NJ State DOH and CMS regulations required with corporate compliance implementation preferred.
• Minimum of 3 years coding and 2 years audit experience in a hospital, consulting firm or practice management setting.
• Proficiency with medical terminology and ICD-10-CM and CPT-4 methodologies.
• Proficiency with physician documentation and reimbursement methodologies.

Licenses and Certifications Preferred:

• Registered Health Information Administrator Certification or Certified Coding Specialist or Certified Professional Coder or Registered Health Info Tech License.
• Certification in Healthcare Compliance (CHC) or the ability to obtain within 6 months.

If you feel that the above description speaks directly to your strengths and capabilities, then please apply today!

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