Position Details

Department: Corporate Compliance
Category: Legal/Risk/Reg Compliance
Location: Phoenix
Posting #: 426668
Date Posted: 12/6/2018
Employee Type: Regular

Position Summary

Posting Note: #PCHCB

At the direction of the Compliance Manager, supports all aspects of compliance program with primary focus on billing, coding and documentation audits. This position provides training and education to the coding and medical staff. This position works with the hospital and physician revenue cycle teams to identify review and resolve coding issues related to billing. This position also assists with general compliance activities.

PCH Values

  • Family-Centered care that focuses on the need of the child first and values the family as an important member of the care team
  • Excellence in clinical care, service and communication
  • Collaborative within our institution and with others who share our mission and goals
  • Leadership that set the standard for pediatric health care today and innovations of the future
  • Accountability to our patients, community and each other for providing the best in the most cost-effective way.

Position Duties

  1. Performs compliance monitoring and auditing of billing, coding and documentation related to inpatient, outpatient surgery, observation, emergency department, urgent care and professional services for all payors.
    • Performs coding and billing audits.
    • Reviews external coder and provider audits/reports.
    • Reviews and prepare compliance audits reports.
    • Assists in the development of training materials and implementation of educational sessions.
    • Assists in the preparation and response to external oversight agency and commercial payor audits, and inquiries including CMS, Medicaid (AHCCCS), RAC, HRSA, PERM, etc.
    • Reviews internal processes to ensure compliance with regulatory requirements.
  2. Miscellaneous Compliance Generalist
    • Responds to identified areas of risk through investigation and internal audit.
    • Maintains a compliance dashboard of all internal monitoring.
    • Assists in the preparation of the annual risk survey and risk assessment.
    • Assists in the preparation and execution of the annual audit plan.
    • Assists in monitoring and responding to Compliance hotline reports.
    • Develops and distributes the compliance newsletter.
    • Assists in monitoring EHR or miscellaneous system access audits.
    • Assists in monitoring and tracking Conflicts of Interest.
    • Tracks compliance investigations in the compliance tracking software.
    • Stays current with changing regulatory requirements through review of periodicals, compliance association newsletters, and review of state and Federal regulatory agency work plans to ensure compliance.
    • Assists in the development and management of learning management systems and compliance training materials.
  3. Performs miscellaneous job related duties as requested.

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Position Qualifications

Please review the following qualifications and specify whether you meet each of the requirements listed.
Do you meet this requirement?
1. Associate degree in Health Information Management or equivalent combination of post-secondary education and experience. Required
Do you meet this requirement?
1. Three years coding and reimbursement experience utilizing ICD-10-CM/PCS, CPT codes, evaluation and management, HCPCS and CPT-4 coding classification systems. Required
2. Experience with auditing concepts and principles. Preferred
3. Experience training in a healthcare setting. Preferred
4. Strong computer skills, including Microsoft Office, Excel, Word, and Powerpoint. Required
5. Strong interpersonal skills. Required
6. Excellent verbal and written communication skills. Required
Do you meet this requirement?
1. Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Certified Coding Specialist (CCS), Certified Professional Coder (CPC). Required
2. Certified in Healthcare Compliance (CHC)/completion of certification within 12 months. Preferred
3. Certified in Healthcare Privacy and Security (CHPS). Preferred
4. Certified Professional Medical Auditor (CPMA). Preferred
Do you meet this requirement?
Special Skills
1. Basic understanding of the roles and responsibilities of State and Federal regulatory agencies to include OIG, CMS, Medicaid (AHCCCS), HRSA, RAC, Etc.. Required
2. Ability to apply knowledge of anatomy, physiology, clinical disease processes, pharmacology, diagnosis and procedural terms to assign the current version of ICD diagnosis and procedure codes. Required
3. Knowledge of proper documentation of medical services and the electronic health record. Required
Physical Requirements & Occupational Exposure/Risk Potential
1. Physical Requirement - Climbing Occasionally
2. Physical Requirement - Feeling (sensing textures and temperatures) Occasionally
3. Physical Requirement - Fine Motor Skills (pinching, gripping, etc) Constantly
4. Physical Requirement - Hearing Constantly
5. Physical Requirement - Pushing/pulling Constantly
6. Physical Requirement - Reaching Constantly
7. Physical Requirement - Sitting Constantly
8. Physical Requirement - Standing Frequently
9. Physical Requirement - Stooping/crouching/kneeling/crawling Constantly
10. Physical Requirement - Talking Constantly
11. Physical Requirement - Tasting/smelling Occasionally
12. Physical Requirement - Walking Frequently
13. Physical Requirement - Near Vision Constantly
14. Physical Requirement - Far Vision Constantly
15. Physical Requirement - Color Discrimination Constantly
16. Physical Requirement - Use of keyboard, mouse and/or computer equipment Constantly
17. Physical Requirement - Lift up to 35 pounds without assistance Occasionally
18. Physical Requirement - Lift more than 35 pounds without assistance Occasionally
19. Occupational Exposure/Risk Potential - Inside office environment Applicable
20. Occupational Exposure/Risk Potential - Confined areas Applicable
21. Occupational Exposure/Risk Potential - Airborne communicable diseases Applicable
I have reviewed the qualifications, physical requirements and occupational exposure/risk potential for this position and wish to apply