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Inspire health. Serve with compassion. Be the difference. Job Summary All team members of the Compliance Department are expected to be knowledgeable and comply with Prisma Health's Code of Excellence to Inspire Health, Serve with Compassion and Be the Difference. In addition, this position requires analytical skills and close attention to detail. This position is responsible for assisting Coding Compliance Manager/Supervisor and Director, Compliance Services in the execution of the annual Coding Compliance Plan. Assists in conducting project planning and developing appropriate audit procedures, and conducts audit procedures and reports findings. Coordinates efforts between the Office of Compliance Services and Physician Practices of the University Medical Group Administration to improve medical record documentation and overall compliance rates.
Remote work may be considered for this position.
Accountabilities
- Under the direction of the Coding Compliance Manager/Supervisor or Senior Coding Compliance Auditor, conducts random reviews of coded professional services in accordance with the Prisma Health Compliance Work Plan. Reviews patient medical records and procedures performed in selected patient care areas to ensure all policies relating to documentation are followed uniformly. Conducts and coordinates routinely scheduled audits of Prisma Health providers' documentation involved with professional fee billing, for accuracy of coding and compliance of regulatory guidelines. These audits consist of, but are not limited to, ambulatory Evaluation and Management services, office procedures as well as hospital admissions, subsequent visits, hospital procedures, and all other services performed or supervised by providers. Analyzes results to assess compliance with regulations, identifies procedural weaknesses and education needs that contribute to instances for non-compliance. Ensures that proper billings from individual patient medical records are justified with proper supporting documentation. Reports document findings in well-organized work papers as reviewed by the Coding Compliance Manager/Supervisor as deemed necessary. Communicates findings and may co-develop corrective action plans for the strengthening of internal controls with management of the audited area.
40% - Independently conducts all project planning procedures for assigned low-moderate complexity audits in a timely manner. May be assigned high complexity audits as warranted.15%
- Under the direction of the Coding Compliance Supervisor, prepares formal written reports summarizing current state (findings), desired future state, and critical success factors (recommendations) for low complexity audits. Reports are accurate, concise, organizationally fluent, and grammatically correct. Applicable Prisma Health policies or federal/state/agency laws or regulations are referenced and explained. Findings are presented in order of importance and are meaningfully condensed and presented in the Office of Compliance Services Executive Summary.
30% - Participates with a Coding Compliance Supervisor or Senior Coding Compliance Auditor directing, in closing meetings with appropriate levels of management. Exhibits confident and competent verbal communication skills. Concisely presents findings and recommended corrective action plans. Cites and summarizes applicable policies, laws or regulations.
- Continuously gains knowledge of CPT, ICD, HCPCS and business/industry/legislative issues relating to and impacting Coding Audit and Compliance issues. Increases knowledge by attending coding conferences, workshops, webinars and in-house sessions to receive updated coding information and changes in coding and/or regulations.
10% - Performs miscellaneous job-related duties as assigned.
5%
Supervisory/Management Responsibilities
This is a non-management job that will report to a supervisor, manager, director or executive.
Minimum Requirments
- Certification Program
- 3 years of CPT, ICD-9/10 and HCPCS professional coding
Work Shift Day (United States of America)
Location 15 Medical Park Rd Richland
Facility 7001 Corporate
Department 70019700 Compliance
Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.
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Prisma Health
remote work
Apr 04, 2025