Hcc Compliance Specialist

Purpose: To conduct quality assurance reviews of physician coding and documentation, to verify and ensure the accuracy, completeness, specificity and appropriateness of diagnosis codes based on services rendered; and to provide education to staff and physicians regarding coding. Some duties and responsibilities include:

1. Serve as a liaison to internal teams, stakeholders, business managers, senior leaders regarding activities and maintenance of the OSUP Compliance Program, to identify key areas for increased exposure; and develop and deliver education as needed.
2. Collaborate with the managed care team to assist with value based payer initiatives, completion of forms and other validation requests.
3. Assist in the development and ongoing maintenance of internal compliance policies and procedures for the OSUP Compliance Program. Collaborate with Compliance Educators, Specialists and leadership to express compliance concerns, issues and potential corrective actions to clinical chairs and administrators.
4. Perform and/or coordinate all investigations of deficiencies resulting from the compliance reporting system or identified through the periodic audits. Coordinate and develop corrective and preventive action for areas identified as non-compliant.
5. Conduct reviews of patient charts and medical record documentation for group faculty to determine accurate CPT, HCPCS procedure, professional supply codes and ICD-9-CM diagnosis codes, including by not limited to those mapped to an HCC at the encounter level.
6. Collaborate with providers, peers and Compliance leadership to obtain additional information and provide further education on coding guidelines. Discuss audit results and provide recommendations where warranted.
7. Keep current with medical compliance and reimbursement policies, such as medical necessity issues and correct coding issues. Maintains knowledge of CMS, state and federal coding rules and regulations. Effectively communicating updates.
8. Develop and deploy tools, documentation, education materials and courses for providers and staff. Provide training and education on coding, documentation and other compliance issues to physicians, non-physician providers, and staff on an ongoing basis.
9. Provide orientation training and education on coding, documentation, PATH and other compliance issues internally in Compliance and externally with physicians and staff.
10. Conduct research on various compliance and documentation issues.
11. Respond to and track third party inquiries regarding level of service coding by the physicians.
12. Perform analyses using Qlik and other internal applications to assist in the development of comprehensive physician coding and compliance education to physicians, residents, APP's and staff inclusive of all current regulations. Including, but not limited to using provider, division and department specific examples and incorporation of regulations and Hierarchy Condition Coding (HCC) initiatives.
13. Assist in updating the OSUP Compliance Program.