Compliance Analyst Rmg

Newport News, Virginia
For over 100 years, at Riverside Health System, we have made it our mission to care for others as we would care for those we love.
Overview
Works under the direct supervision of the Director of Coding and Compliance. Primary responsibility is to perform risk adjustment audits, clinical chart reviews, coding analyses, charge/reimbursement analyses, medical records reviews, and educate provider personnel on coding methodologies that will result in improved accuracy by following RMG compliance standards for commercial and government payors. This position also serves as the point of coordination within the department for the review and root cause analysis of charge review work queues, coding denial volumes, and coding trends. Responsible for identifying and reporting obstacles, patterns, and variations as well as resolutions in a timely, clear and concise manner. Serves as an expert for all coding-related questions and is responsible for timely providing educational materials to answer questions from clinical/office managers, providers and other administrative personnel. Responsible for researching all new CPT codes for coverage and reimbursement. May perform the most complex coding and abstraction work. Works closely with RHS Internal Audits. This position requires a strong attention to detail, problem solving skills, aptitude for learning, critical thinking, independent working and ability to make sound business judgments. This person will serve as a leader and role model for the department by displaying a positive, patient centered, and solution oriented approach and attitude.
What you will do

• Conducts Medical Record audits following official coding guidelines and interprets and applies Federal and State regulations, coding and billing requirements for Baseline, Semi-Annual, Post Education and Focused provider chart reviews.
• Analyzes provider coding and documentation to evaluate risks relating to future payor recovery audits. Reports and tracks necessary corrections to ensure compliance with payor rules and regulations with appropriate databases.
• Ensures that all Third Party Payor reviews are completed timely with all requested supporting documentation (e.g. Medical records). Researches payor rules (e.g. manuals, policies and other sources) for support and guidance. Pre-reviews files and materials and provides summary of findings so that issues can be shared with the department director. Works in alliance with RHS Internal Auditing.
• Provides providers, practices, coding managers, coding team and administration with assistance and guidance. Answers questions and solves complex coding problems which includes performing preliminary research on topics such as coverage determinations, coding guidelines or standards of care.
• Reviews and analyzes coding related to 1) ensuring work queues are worked timely and accurately and reporting concerns to department managers, and/or Director, 2) identifying trends, 3) conducting root cause analysis of trends, and 4) developing action plans for corrective action. Makes recommendations to Manager and practices/departments, including Patient Accounting (CBO), Physicians and Contracting to resolve the denied claims and provide education to reduce future denials.
• Works in alliance with RHS/RMG medical record vendor and facilities to process medical release of information requests for RMG practices. Ensures compliance to all HIPAA guidelines/regulations. Reports deficiencies and problems to improve patient experience.
• Audits both aggregate coded data and individual encounter data to independently determine opportunities for education, training and documentation improvement for both individual providers and RMG Coding team. Provides feedback and suggestions to providers/coders regarding coding accuracy. Identifies trends and opportunities for improvement in clinical documentation and reports this information to the Director.
• Works with newly hired team members' orientation program to ensure understanding of office based payor regulations (ABN, HIPAA, Incident to/shared visits). Oversees the department's new team member and reports on evaluation results with any recommendations as needed. Assists with and/or provides suggestions for continuing education topics and issues for coding staff. Interacts with and educates coding staff in specialty topics. Develops and maintains all presentations and tracking logs.
• Works collaboratively with both internal and other departments to resolve complex issues with solutions and identifies opportunities for improved efficiency (e.g., financial, customer service, optimization).

• Associates Degree, (Preferred)

• 1-3 years Commercial and Government Billing/Coding/Collections (Required)
• 1-3 years Medical Record Reviews (Required)

• Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC) (Required)
• Certified Outpatient Coder (COC) - American Academy of Professional Coders (AAPC) (Required)
• Certified Physician Practice Manager (CPPM) - American Academy of Professional Coders (AAPC) (Required)

• Medical Plan Options
• Vision and Dental plans (including orthodontic care)
• Wellness & fitness center discounts
• Onsite pharmacy and delivery options
• Riverside Health System services discount
• Flexible spending and savings accounts
• Healthy lifestyle incentives

• Group Term Life and AD&D Insurance
• Short Term Disability
• Whole Life Insurance
• Critical Illness Insurance
• Accident Insurance
• Legal Insurance
• Pet Insurance

• CEUs (MedBridge Education)
• 403(b) Savings Plan (Immediate Matching)
• Specialty Certification Financial Assistance
• Company Wide Bonus Program
• Employee Help Fund

• Paid Time Off (full- and part-time team members)
• Extended illness bank
• Employee Assistance Program
• Adoption Assistance
• Area retail discounts
• Community involvement opportunities