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Duke Health logo
Duke Health

Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status. Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values. Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.

COMPLIANCE SPECIALIST

Location

United States

Posted

36 days ago

Salary

0

Seniority

Mid Level

No structured requirement data.

Job Description

COMPLIANCE SPECIALIST

Duke Health

Role Description At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together. Patient Revenue Management Organization is the fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions for Duke Health. This position is 100% remote. All Duke University remote workers must reside in one of the following states: - North Carolina - Alabama - Arizona - Connecticut - District of Columbia - Florida - Georgia - Illinois - Iowa - Kentucky - Louisiana - Maine - Michigan - Missouri - Montana - New Hampshire - Ohio - Oregon - Pennsylvania - South Carolina - Tennessee - Texas - Virginia - Washington Qualifications - Education: Bachelor's degree program. - Experience: Four years of administrative experience in compliance, coding, and auditing principles related to insurance billing and revenue cycle functions. - Technical Coding: Two of the four years of experience with DRGs and APR-DRGs required. - Preferred: Experience in formal teaching of coding. - Certifications: RHIA, RHIT, or CCS required; CPC or CPMA preferred for professional coding. Requirements - Implement and maintain compliance programs in accordance with the Office of Inspector General's work plan. - Educate providers regarding compliance with government regulations, focusing on Medicare and Medicaid guidelines, HIPAA, and Fraud and Abuse. - Assist in performing analysis of current situations and recommend priorities and goals for future clinic needs. - Identify coding and billing risk areas, conduct focused reviews, and implement corrective action as needed. - Conduct routine internal audits of provider documentation on a timely basis. - Collaborate with physicians and internal staff to improve documentation, coding, and compliance capabilities. - Review internal controls, policies, and procedures for compliance with guidelines and sound business practices. - Respond promptly to external and internal concerns; implement corrective actions as appropriate. - Communicate with Medicare/Medicaid carriers and third-party payers regarding policies and procedures. - Promote compliance initiatives with clinical faculty and administration. - Perform other related duties incidental to the work described herein. Benefits - Duke is an Equal Opportunity Employer. - Commitment to providing employment opportunity without regard to age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or military status. - Focus on collaboration, innovation, creativity, and belonging. - Encouragement of a community built on the robust exchange of ideas and respect for diverse perspectives. Essential Physical Job Functions Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.

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