Coding Compliance Specialist

Employment Type:

Full time Shift:

Description: Responsible for the data capture, analysis & reporting of data information to assist the Trinity Health leadership team achieve operational efficiency. Responsible for auditing of department information, producing reports, & suggesting improvements to processes. Provides knowledge & expertise in the program, services & applications. Assists management in conducting annual and periodic risk assessments in support of the Trinity Health Integrity & Compliance Program (ICP). Risk assessments consider legal and regulatory compliance risks applicable to Trinity Health operations as identified by Department of Health & Human Services (DHHS) - Office of Inspector General (OIG), Centers for Medicare & Medicaid Services (CMS), Department of Justice (DOJ) as well as input received from internal Trinity Health stakeholders. Prepares written reports and presentations on the results of risk assessment activities.
Assists management in the development & performance of activities to assess the ongoing effectiveness of Trinity Health's Integrity & Compliance Program (ICP). Provides assistance with monitoring changes in laws, regulations and business ethics practices impacting corporate compliance programs. Assists management in ensuring the ICP
fully meets all requirements for effective corporate compliance programs as established by health care industry regulators.

Minimum Qualifications
Bachelor's degree in a health care related field, or an equivalent combination of education & clinical reviews/coding/billing experience.
Minimum of three years of experience including clinical documentation & coding reviews. Must possess working knowledge of Medicare & third-party payer regulations and demonstrated knowledge & understanding of the laws & regulations impacting the health care provider industry, specifically health care corporate compliance programs & relevant knowledge in areas like revenue cycle, coding & billing, physician financial relationships, conflicts of interest and/or clinical research. Must possess detailed knowledge of federal, state & local laws & regulations impacting health care corporate compliance programs.
Must possess in-depth knowledge of CPT, HCPCS, ICD-10-CM & ICD-10-PCS coding & billing regulations required. AHIMA, AAPC, or equivalent certification required, e.g., Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Registered Health Information Technologist (RHIT), or Registered Health Information Administrator (RHIA).

Certification in Healthcare Compliance ("CHC") designation or willingness to obtain certification within two (2) years of hire.

Must possess a thorough understanding & knowledge of health care legal & regulatory practices, financial & internal control systems/procedures. Must understand and have in depth knowledge of Hospital Outpatient Prospective Payment System, Inpatient Prospective Payment System, Medicare Physician Fee Schedule, Inpatient Psychiatric Prospective Payment System, Ambulatory Surgery Center Payment System, Provider-Based requirements, EMTALA, Price Transparency & No Surprises Act regulations. Must have extensive knowledge in the guidance outlined in the Medicare Claims Processing Manual, Medicare Program Integrity Manual, & National Correct Coding Initiative (NCCI) Policy Manual.

Additional Qualifications (nice to have)
Possess & maintain licensure or certification in compliance, law, audit, privacy, healthcare, or other relevant field or area of study. Experience with government audits, inquiries, investigations, response, & mitigation.
Experience supporting compliance program operations such as policy management, training & education programs, & investigations preferred.
Master's or professional degree in law, business or health care.

Physical & Mental Requirements & Working Conditions (General Summary)
Direct Healthcare Services / Indirect Healthcare / Support Services:
Exposure to conditions which may be considered unpleasant to sight, touch, sound & / or smell. Occasional
Exposure to fumes, odors, dusts, mists & gases, biohazards / hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.). Occasional
Exposure to or subject to noise, infectious waste, diseases & conditions. Occasional
Exposure to interruptions, shifting priorities & stressful situations. Frequent
Ability to follow tasks through to completion, understand & relate to complex ideas / concepts, remember multiple tasks & regimens over long periods of time & work on concurrent tasks / projects. Frequent
Ability to read small print, hear sounds & voice / speech patterns, give / receive instructions & other verbal communications (in-person & / or over the phone / computer / device / equipment assigned) with some background noise. Frequent

Hourly pay range: $31.25 - $46.88

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.