Compliance Analyst RMG

This position is remote work eligible for candidates residing in the following states: FL, GA, ID, KS, KY, MS, NC, OK, SC, SD, TN, VA.

• →Independently conducts Medical Record audits following official coding guidelines and interprets and applies Federal and State regulations, coding and billing requirements for Baseline, Annual, Post Education and Focused provider chart reviews. Analyzes provider coding and documentation to evaluate risks relating to future payor recovery audits. Uses expertise and discretion to apply necessary corrections to ensure compliance with payor rules and regulations with appropriate databases.
• →Demonstrates expertise and ensures that all Third Party Payor reviews are completed timely with all requested supporting documentation (e.g. Medical records). Researches payor rules (e.g. manuals, policies and other sources) for support and guidance. Pre-reviews files and materials and provides summary of findings so that issues can be shared with the department director. Works in alliance with RHS Internal Auditing. Reports and tracks necessary corrections to ensure compliance with payor rules and regulations with appropriate databases.
• →Analyzes coding related to 1) ensuring work queues are worked timely and accurately and reporting concerns to department managers, and/or Director, 2) identifying trends, 3) conducting root cause analysis of trends, and 4) developing action plans for corrective action. Makes recommendations to Manager and practices/departments, including Patient Accounting (CBO), Physicians and Contracting to resolve the denied claims and provide education to reduce future denials.
• →Audits both aggregate coded data and individual encounter data to independently determine opportunities for education, training and documentation improvement for both individual providers and RMG Coding team. Provides feedback and suggestions to providers/coders regarding coding accuracy. Identifies trends and opportunities for improvement in clinical documentation and reports this information to the Director.
• →Works with newly hired team members’ orientation program to ensure understanding of office based payor regulations (ABN, HIPAA, Incident to/shared visits). Oversees the department’s new team member and reports on evaluation results with any recommendations as needed. Assists with and/or provides suggestions for continuing education topics and issues for coding staff. Interacts with and educates coding staff in specialty topics. Develops and maintains all presentations and tracking logs.
• →Works collaboratively with both internal and other departments with assistance and guidance. Answers questions and solves complex coding problems which includes performing preliminary research on topics such as coverage determinations, coding guidelines or standards of care with an emphasis on improving efficiency.

• High School Diploma or GED, (Required)

• 3-4 years Commercial and Government Billing/Coding/Collections (Required)
• 1 year Medical Record Reviews (Required)

• Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC) (Required) or
• Certified Outpatient Coder (COC) - American Academy of Professional Coders (AAPC) (Required) and
• Certified Professional Medical Auditor (CPMA) - American Academy of Professional Coders (AAPC) or another AAPC recognized credential, or billing within 1 Year (Required)

To learn more about being a team member with Riverside Health System visit us at https://www.riversideonline.com/careers.