Medical Coding Compliance Specialist

Entourage is accepting resumes for this role:

Medical Coding Compliance Specialist
Place of Performance: Japan

Specific Tasks:

• Evaluate and identify root causes of non-compliance with official coding policies, regulations, requirements, and standards.
• Perform and report investigations related to noncompliance in a fair, objective, and discrete manner.
• Review encounter and/or record documentation to identify inconsistencies or discrepancies that may cause inaccurate coding, medico-legal repercussions or impacts quality patient care, identifying any problems with legibility, abbreviations, etc., proper sequence of documents, presence of authorized signatures, and sufficient data is documented that supports diagnosis, treatment administered, and results obtained.
• Research questions from staff regarding regulatory compliance, providing accurate, detailed, and timely responses.
• Conducts focused or targeted audits, analyzing information, identifying deficiencies, developing reports, and formulating recommendations for corrective action.
• Participates in the development of internal controls and systems to mitigate risk.
• Conduct organizational risk assessments.
• Assist in maintaining reporting system(s) to enable employees to report an noncompliance (e.g., hotline).
• Respond to compliance concerns expressed by employees through internal reporting.
• Communicate suspected noncompliance through appropriate channels
• Ensure compliance investigations are documented and records are maintained according to requirements to include follow-up on corrective action plans implemented.
• Support maintenance of the CDM, reviewing and recommending improvements to organizational CDM structures to ensure that CDMs accurately reflect services and supplies provided and are consistent with current industry best practices.
• Ensure that leadership is knowledgeable about revenue assurance needs and reimbursement issues identified through audits, reviews, and aggregate data analysis.
• Stays abreast of industry changes to code sets and coding guidance. Analyzes changes to coding rules and regulations by utilizing appropriate reference materials, internet sources, seminars, and publications. Stays abreast of changes in Federal laws, Department of Health and Human Services Office of Inspector General (HHS-OIG), DoD, and DHA regulations, and commercial policies involving or affecting compliance.
• Develop and execute revenue integrity projects to resolve identified revenue leakage issues, documenting analysis, recommendations, implementation efforts, evaluation of implemented solutions, and return on investment (ROI) determination.
• Educates and provides feedback to providers and clinical staff to resolve documentation issues to support coding compliance.
• Acts as a source of reference to medical staff having questions, issues, or concerns related to coding. Responds to provider questions and provides examples of appropriate coding and documentation reference(s) to provide clarity and understanding. Collaborates with and supports medical coders, auditors, and trainers in providing education and feedback to providers and staff.
• Supports DHA coding compliance by performing due diligence in ethically and appropriately researching and/or interpreting existing guidance, including seeking clarification through appropriate channels.
• Achieve and maintain DHA coding productivity and accuracy standards for the position.

Qualifications:

• Education: Post-high school education through a university or technical school program resulting in completion of ONE of the following: 1) An Associate’s degree or higher in Health Information Management, Healthcare Administration, or a biological science; OR 2) A university certificate in medical coding; OR 3) At least 30 semester hours’ university/college credit that includes relevant coursework such as anatomy/physiology, medical terminology, health information management, and/or pharmacology; OR 4) Successful completion of an American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) coding certification preparation course for professional services or facility coding that includes medical terminology, anatomy and physiology, health information management concepts, and pharmacology; OR 5) Successful completion of a training course beyond apprentice level for medical technicians, hospital corpsmen, medical service specialists, or hospital training, obtained in a training program given by the Armed Forces or the U.S. Maritime Service under close medical and professional supervision.
• Certification: ONE of the following recognized professional coding certifications: Certified Professional Coder (CPC), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or Certified Coding Specialist – Physician (CCS-P); AND ONE of the following recognized institutional coding certifications: Certified Inpatient Coder (CIC), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS); AND ONE of the following recognized coding compliance certifications: AAPC: Certified Professional Compliance Officer (CPCO), or Health Care Compliance Association (HCCA): Certified in Healthcare Compliance (CHC); and Certification in Healthcare Revenue Integrity (CHRI) from National Association of Healthcare Revenue Integrity (NAHRI).