Job Description

University of Utah Job Description

Job Summary

Ensures patient billing practices conform to government reimbursement guidelines by monitoring current practices, managing and documenting audit processes, developing and implementing systems to track compliance activities and providing compliance education.

Qualifications

Bachelor’s degree in Health Care Administration, Business Administration or a related field plus five years regulatory or administrative law experience, with at least three of those years in a health care setting or equivalency (one year of education can be substituted for two years of related work experience); coding certification (CPC, 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.

Knowledge of utilization review and quality assurance procedures is preferred. An understanding of University operations, policies and technology is preferred. Training or teaching experience is also preferred.

This position is patient-sensitive and must fulfill all associated vaccination requirements, or be approved for an exemption, prior to the first day of work. We protect our patients, coworkers and community by requiring all patient-sensitive employees to be immunized according to CDC standards and hospital policy. Limited exemptions may be made for documented medical contraindications or religious beliefs that object to vaccinations.

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. Oversees, coordinates and conducts audits on documentation, abstraction and coding to ensure compliance with University, state and federal guidelines.
2. Analyzes and documents audit processes. Recommends enhancements to operating policies and procedures for compliance review.
3. Monitors and follows up on required documentation related to audit processes.
4. Develops, monitors, and updates quality control systems to track compliance activities. Identifies trends, issues and risk areas and makes recommendations for improvement.
5. Develops, coordinates and participates in educational and training programs to enhance compliance and awareness of compliance issues.
6. Teams with faculty and staff to assist departments in implementing compliance practices and monitors and coordinates those activities with the departments.
7. Maintains current knowledge regarding federal and state guidance, organizational needs, and payer regulations. Serves as an expert resource in issue resolution.

Problem Solving

Incumbent is responsible for assisting the University in preparation for regulatory audits by developing, monitoring and updating quality controls and recommending actions to maintain compliance. This position is the primary contact and expert regarding regulatory agency standards governing healthcare program requirements. Representative challenges of this position include determining the validity of collected data, assessing process shortfalls, and developing effective safeguards to reduce risk. The incumbent must possess the ability to foster collaborative working relationships with a wide range of constituencies.

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.

The staff member must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit.  The individual must demonstrate knowledge of the principles of life span growth and development and the ability to assess data regarding the patient's status and provide care as described in the department's policies and procedures manual.