How have you impacted someone's life today? At Hackensack Meridian Health our teams are focused on changing the lives of our patients by providing the highest level of care each and every day. From our hospitals, rehab centers and occupational health teams to our long-term care centers and at-home care capabilities, our complete spectrum of services will allow you to apply your skills in multiple settings while building your career, all within New Jersey's premier healthcare system.
The Compliance Specialist is responsible for assuring on-going compliance by actively participating in the Compliance Program. In consultation with the Director of Corporate Compliance the Compliance Specialist proactively assesses changes in the regulatory environment; researches, investigates and responds to issues related to accreditation, documentation, coding and licensure. Coordinates and participates in the record/claims review process, provides documentation and compliance education sessions to physicians and other staff. The Compliance Specialist may assist the Director of Corporate Compliance with other aspects/projects/tasks/reviews of the Compliance Program to assure compliance with licensure, accreditation and other applicable state and federal regulations.
A day in the life of a Compliance Specialist at Hackensack Meridian Health includes:
- Investigates, responds to and communicates information regarding, documentation, coding, compliance and reimbursement.
- Facilitates timely, accurate and complete documentation.
- Assists in identifying appropriate documentation requirements for specialized services.
- Support, provide analysis for and advise senior management regarding coding and documentation impact on accreditation, revenue and reimbursement issues.
- Analyze and trend coding issues/questions from both a compliance and regulatory perspective.
- Works with Health Information Staff to assure appropriate documentation standards in support of ethical coding and data abstraction for public reporting.
- Ensures the appropriate dissemination and communication of regulation, policy and guideline changes to affected personnel.
- Provide compliance education to leadership, physicians and other team members as required.
- Provide accurate and up to date information on regulatory and reimbursement requirements.
- Provide documentation and coding expertise for all compliance and reimbursement issues.
- Prepare reports and graphics for presentation.
- Maintain attendance lists for all presentations and log of issues raised and identified for future research and response.
- Develop educational materials related to documentation, compliance and reimbursement, for physicians and other staff.
- Develops and maintains policies as required.
- Coordinates and perform compliance reviews/audits for outpatient and inpatient services.
- Conducts audits and investigations as part of the compliance work plan. May conduct reviews under the direction of counsel as required.
- In accordance with goals established by the Director of Corporate Compliance, complete reviews within established timeframes, analyze results and prepare formal reports with findings and recommendations.
- Consult with physicians and other clinical staff for clarification of clinical data when ambiguous information is encountered.
- Facilitate and improve staff understanding of regulatory and payer requirements by providing feedback related to documentation information.
- Participate in the revenue cycle process to ensure both compliance and the maximization of appropriate departmental reimbursement.
- Participate in regular meetings with coding, billing, abstraction and reimbursement staff to review claims, evaluate accuracy and develop appropriate strategies for addressing errors.
- Review requests from insurers and patient families for copies of patient medical charts and/or changes in codes/fees.
- Participate in the development and implementation of systems/procedures related to rejection and follow-up strategies.
Education, Knowledge, Skills and Abilities Required:
- 4-year Bachelor's degree in Business Management or related law/health field.
- Computer proficiency and demonstrated presentation skills required.
Education, Knowledge, Skills and Abilities Preferred:
- Master's degree in Business Management or related law/health field.
- 3-5 years in a healthcare compliance role, or equivalent
- Familiarity with TJC, NJ State DOH and CMS regulations required with corporate compliance implementation preferred.
- Minimum of 3 years coding and 2 years audit experience in a hospital, consulting firm or practice management setting.
- Proficiency with medical terminology and ICD-10-CM and CPT-4 methodologies.
- Proficiency with physician documentation and reimbursement methodologies. Licenses and Certifications Required: Licenses and Certifications Preferred:
- Registered Health Information Administrator Certification or Certified Coding Specialist or Certified Professional Coder or Registered Health Info Tech License.
- Certification in Healthcare Compliance (CHC) or the ability to obtain within 6 months.
As a courtesy to assist you in your job search, we would like to send your resume to other areas of our Hackensack Meridian Health network who may have current openings that fit your skills and experience.