| Job
Code: |
1342
|
| Job
Title: |
Compliance
and Reimbursement Review Coordinator
|
| Creation
Date: |
07/19/01
|
|
| Revision
Date: |
01/04/06 |
| FLSA
Status: |
Exempt |
Job Summary:
To develop and provide a standardized monitoring program for facility and professional coding and billing. To assist with development and implementation of pre and post audit education for the coding and reimbursement specialist, the departments, and the physicians.
Major Duties / Critical Tasks:
-
Develops and implements a standardized process for routine monitoring of inpatient and outpatient coding and billing.
-
Develops and implements a standardized process for focused monitoring as identified.
-
Works with the Compliance Coding Education Coordinator (CCEC) and the Program Manager (PM) to develop pre-audit education for the CRRS team.
-
Works with the CCEC and the PM to develop coder education and physician education to address issues identified by monitoring activities.
-
Assists with analysis of data/reports from compliance monitoring activities to help identify trends, issues, risk areas, and opportunities for education and/or process improvement.
-
Prepares and presents reports summarizing monitoring activities.
-
Supports activities that identify other areas of coding education opportunities (e.g., Medicare pre-payment review requests).
-
Works with the Manager of Compliance Training and Education to develop alternative training methods, including web-based training programs.
-
Keeps PM informed of progress.
-
Manages the monitoring activities so time is used efficiently and departmental quality management standards are met.
-
Maintains current fund of knowledge regarding federal, state, and local coding and compliance guidance, initiatives, work plans, and payer regulations.
-
Communicates and provides this information to the CRRS team.
-
Ensures that monitoring education is updated appropriately to reflect regulatory changes.
-
Establishes and maintains excellent interdepartmental relationships with clinical and business administration management to facilitate cooperation and compliance.
-
Provides information and/or advice to PM, Director, and Executive Directors.
-
Formulates alternative solutions to problems and obtain acceptance and action on important to the monitoring program.
-
Adheres to internal controls established for the department.
-
Completes other job-related functions and special projects as assigned by the PM.
Required Education / Experience:
Bachelor’s Degree or equivalent in related field and four years related experience. CPC certified or equivalent.
Equipment:
Standard office equipment.
Working Environment:
Standard office and patient care environments.
Other:
Specific job requirements or physical location of some positions allocated to
this classification, may render this position security sensitive, and thereby
subject to the provisions of Section 51.215, Texas Education Code.
Any
qualifications to be considered as equivalents in lieu of stated minimums
require the prior approval of the Chief Human Resources Officer.
