COMPLIANCE SPECIALIST

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

Pursue your passion for caring with the Patient Revenue Management Organization, which 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.

Occ Summary

Implement and maintain compliance programs in accordance with the Office of Inspector General's work plan to reduce institutional and individual provider legal and financial risk through education and internal audits.

Work Performed

Educate providers regarding compliance with government regulations with special attention to Center for Medicare and Medicaid guidelines as they pertain to academic medical centers, HIPAA, and fraud and abuse with periodic updates. Assist in performing an 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 in the development of improved capabilities in the areas of documentation, coding, and compliance. Review internal controls, policies, and procedures to ensure compliance with appropriate university, state, and federal guidelines and policies, sound business and finance practices, and overall clinical goals and objectives. Respond promptly to external and internal concerns; implementingcorrective 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.

Knowledge, Skills and Abilities

Educate providers regarding compliance with government regulations with special attention to Center for Medicare and Medicaid guidelines as they pertain to academic medical centers, HIPAA, and fraud and abuse with periodic updates. Assist in performing an 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 in the development of improved capabilities in the areas of documentation, coding, and compliance. Review internal controls, policies, and procedures to ensure compliance with appropriate university, state, and federal guidelines and policies, sound business and finance practices, and overall clinical goals and objectives. Respond promptly to external and internal concerns, implementing 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 otherrelated duties incidental to the work described herein.

Level Characteristics

Educate providers regarding compliance with government regulations with special attention to Center for Medicare and Medicaid guidelines as they pertain to academic medical centers, HIPAA, and fraud and abuse with periodic updates. Assist in performing analysis of current situations and recommend priorities and goals for future clinic needs. Identify coding and billing risk areas, conduct focusedreviews, and implement corrective action as needed. Conduct routine internal audits of provider documentation on a timely basis. Collaborate with physicians and internal staff in the development of improved capabilities in the areas of documentation, coding, and compliance. Review internal controls, policies, and procedures to ensure compliance with appropriate university, state, and federal guidelines and policies, sound business and finance practices, and overall clinical goals and objectives. Respond promptly to external and internal concerns, implementing 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.

Minimum Qualifications

Education

Work requires organization, analytical and communication skills generally acquired through the completion of a Bachelor's degree program.

Experience

Four years of administrative experience to acquire competence in applying compliance, coding and auditing principles as they relate to insurance billing, collections, consulting, and other revenue cycle-related functions. For technical coding, two of the four years of experience with DRGs and APR-DRGs are required. Experience in formal teaching of coding is preferred. RHIA or RHIT or CCS required. For professional coding, specialty coding experience in surgical or E/M coding is preferred. CPC or CCS or RHIT or RHIA or CPMA is required.

Degrees, Licensures, Certifications

Four years of administrative experience to acquire competence in applying compliance, coding and auditing principles as they relate to insurance billing, collections, consulting, and other revenue cycle-related functions. For technical coding, two of the four years of experience with DRGs and APR-DRGs are required. Experience informal teaching of coding is preferred. RHIA or RHIT or CCS required. For professional coding, specialty coding experience in surgical or E/M coding is preferred. CPC or CCS or RHIT or RHIA or CPMA is required.