University of Utah Job Description
Job Summary
Provides leadership and support conducive to the management of team of Compliance Officers and administrative staff. Conducts scheduled and unscheduled inpatient, outpatient, and professional audits and projects related to billing and payment integrity, workflow, and duties in order to ensure accurate and timely responses to governmental contractors. Oversees, coordinates, and conducts audits on documentation, abstraction, and coding to ensure compliance with University, State, and Federal guidelines.
Qualifications
Bachelor’s Degree in Health Care Administration, Business Administration or a related field, or equivalency (one year of education can be substituted for two years of related work experience); plus seven years working experience, with at least four of those years in a compliance office or the equivalent; the American Health Information Management (AHIMA) or American Academy of Professional Coders (AAPC) recognized coding certification (CPC, CPC-H, ACS, CCS-P/H, RHIA); knowledge of medical auditing, Federal healthcare program policies and requirements (including Medicare Parts A and B), and ICD-10, CPT, HCPCS, DRG coding; proficient with word processing, spreadsheet and related computer applications; demonstrated human relations and effective communication skills also required.
Master’s Degree in a related field is preferred. Certification from the Healthcare Compliance Association (HCCA) as a Compliance Officer is preferred.
This position is not responsible for providing patient care.
Applicants must demonstrate the potential ability to perform the essential functions of the job as outlined in the position description.
Disclaimer
This job description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to the job.
Essential Functions
1. Manage workflow and tasks, provide leadership, direction and support to compliance officers
2. Oversees, coordinates, and conducts scheduled and unscheduled billing and coding audits to ensure compliance with University, State, and Federal guidelines.
3. Assist the University in preparation for regulatory audits, by developing, monitoring, and updating quality controls and recommends actions to maintain compliance.
4. Reports non-compliance and recommended corrective actions related to billing compliance issues to the University of Utah Health Sciences Compliance Oversight Committee.
5. Designs and enacts educational planning and enactment for required State, Federal, and Payer monitoring and training for the University of Utah faculty, students, and employees.
6. Recommends enhancements to facility and professional operating policies and procedures, based on audit results and/or billing and payment integrity data.
7. Teams with providers, managers and staff to assist departments, clinics, and/or service lines in implementing, coordinating, and monitoring compliance practices. 8. Serves as an expert resource in issue resolution
Problem Solving
This position is primarily responsible for prioritizing governmental and internal audit requests and needs based on risk, timelines, and available skilled personnel. This individual must be highly skilled in high performance leadership, time management and possess strong communication skills. This individual will work with his/her team to evaluate the task assignments, review each compliance officer’s and support staffer’s skill and knowledge level, and assign tasks accordingly.
Comments
Work Environment and Level of Frequency typically required
Nearly Continuously: Office environment.
Physical Requirements and Level of Frequency that may be required
Nearly Continuously: Sitting, hearing, listening, talking.
Often: Repetitive hand motion (such as typing), walking.
Seldom: Bending, reaching overhead.
