Job Description

General Purpose of Job:  

Ensure Revenue Cycle Coding and Billing are compliant with State and Federal regulations.  Respond to and Investigate compliance issues within Revenue Cycle.   Lead and/or coordinate audit activity with governmental audits.  

Essential Duties:

This job description is intended to cover the minimum essential duties assigned on a regular basis.  Team members may be asked to perform additional duties as assigned by their leader.  Leadership has the right to alter or modify the duties of the position.

• Ensures conformance with applicable laws, regulations and Medicare/Medicaid reimbursement rules to ensure UMHS is in compliance with federal, state and/or local regulations. Monitors, analyzes and reports on laws, regulations, audits and industry standards that impact the organization.


• Develops and maintains Professional and Hospital billing issues on the Revenue Cycle Compliance Work Plan. Reviews the OIG Work Plan, recent payer audits (including OIG Reports), industry communications and other resources to establish and prioritize.


• Recommends appropriate actions based on findings.


• Responsible for reviewing, writing and updating Revenue Cycle Billing policies and procedures to ensure that the Revenue Cycle operations are in compliance with all federal and state regulations, payer rules and other reimbursement requirements.


• Works with Revenue Cycle Management and other staff to investigate compliance issues. Participates, leads and collaborates with members of Revenue Cycle Billing Policy/Compliance work groups to address compliance and billing operations issues. Coordinates/collaborates on the response to OIG subpoena's or other government agency subpoenas.


• Collaborates with other health system units including but not limited to Health System Legal Office, UMHS Compliance Office and Office of Clinical Affairs to ensure appropriate communication on regulatory issues.


• Responds to inquiries from billing units and clinical departments regarding compliance issues. Investigates and issues reports on identified compliance issues. Provides staff support to Corporate Compliance Audit Committee (CCAC). Monitors laws, regulations and standards that impact the organization. Provides education on applicable rules and regulations and to improve operational process.


• Provides clinical and operational expertise for the RCE team. Serves as a department expert on third-party payer issues, including working closely with the Revenue Cycle Third Party Payer staff to ensure compliance with rules, regulations and contractual obligations.


• Ensure the Revenue Cycle policies on internal and external websites are up to date. Serves as the lead for all Non-Physician Practitioners (NPP) billing and documentation issues and projects including reviewing changes to NPP requirements by payers.


• Works with the lead Physician Assistant, the Ambulatory Care lead for Nurse Practitioner issues and UMHS Nursing.

Job Requirements

General Requirements	• Must have one of the following: o Certified in Healthcare Compliance (CHC) by the Health Care Compliance Association (HCCA) o Certified Professional Coder (CPC) by the American Association of Procedural Coders (AAPC) o Certified Inpatient Coder (CIC) by the American Association of Procedural Coders (AAPC) o Certified Coding Specialist (CCS) by the American Health Information Management Association (AHIMA) o Registered Health Information Management Technician (RHIT) or Registered Health Information Administrator (RHIA) by the American Health Information Management Association (AHIMA)
Work Experience	• Minimum 5 years of either coding experience for inpatient and outpatient records, or revenue cycle management or equivalent work experience • 2-5 years of professional experience as a coding/HIM manager or documentation specialist in a hospital or health system or revenue cycle management preferred
Education	• Bachelor's degree in Health Information Management, or other healthcare related field • Master's degree preferred • Formal course study in Human Anatomy and Physiology, ICD and CPT coding, and Medical Terminology preferred
Specialized Knowledge and Skills	• Knowledge of ICD coding classification systems • Working knowledge of coding for third-party payers, including CMS guidelines and reimbursement compliance • Knowledge of health information systems and database technology • Able to communicate effectively with team members and management • Detail-oriented, good organizational skills, analytical, strong problem solving/investigative skills, and ability to be self-directed • Ability and willingness to exhibit behaviors consistent with standards of performance improvement and organizational values (e.g., efficiency & financial responsibility, safety, partnership & service, teamwork, compassion, integrity, and trust & respect) • Demonstrate personal integrity, enthusiasm and empathy to internal and external customers • Knowledge of HIPAA and other compliance requirements preferred • Knowledge of MiChart (Epic) preferred • Knowledge of University policies and procedures preferred