Coding, Billing & Reimbursement Compliance Officer

1 CBR Compliance OfficerApex Medical Center1999 Page - 1 - coding , Billing & Reimbursement Compliance OfficerApex Medical CenterJob Description: With limited supervision from the chief ComplianceOfficer identifies, investigates and resolves all Compliance issues relatingto coding , Billing , documentation and Reimbursement activities. Asappropriate, acts as the team leader for special Compliance investigationsin coding , Billing and Reimbursement including formal and informal audits,cost reporting, charge master, computer Billing system, and variouscompliance related computer Activities:Reviews and studies all information published by HCFA and the OIG viathe Federal Register, fraud alerts, OIG advisory opinions, and otherpublications relative to coding , Billing and Reimbursement and studies all information from third party payers relative toclaims filing, coding , and the adjudication to and reviews various publications both in written form andthrough the Internet relative to coding , Billing and , assesses, studies, analyzes the overall coding , Billing .

2 Documentation and Reimbursement system for potential complianceproblems and non-compliant a systematic approach for the identification and resolution ofcomplex Compliance with health information management, patient accounts, informationsystem and other medical center personnel to solve and implementsolutions to maintain a proper Compliance with the chief Compliance Office and medical center legal counselrelative to difficult coding , Billing and Reimbursement Compliance with charge master and cost report personnel relative tomaintaining proper Compliance with various rules and with contract management personnel in the review of contracts andother Reimbursement or payment with the chief Compliance Officer in the development and ongoingactivities involved in the baseline and periodic Compliance informal audits on various aspects of the coding , Billing ,documentation and Reimbursement and conducts formal audits of specific aspects of the overallcoding.

3 Billing and Reimbursement and directs technical teams in the investigation and resolutionof complex Compliance Compliance OfficerApex Medical Center1999 Page - 2 -Works with medical center legal counsel in developing systems to meetany requirements in a Compliance settlement agreement includingtraining, reporting and computer system training sessions for both general and specific problemresolution in the coding , Billing and Reimbursement and assists others in writing various types of policies andprocedures in order to maintain proper workshops and seminars to maintain a high level of knowledgeand and coordinates the use of consultants for specializedactivities relative to the coding , Billing a Reimbursement Compliance and facilitates problem resolution sessions where multipledepartments and/or service areas are overall Compliance in the coding , Billing .

4 Documentation andreimbursement with upper management and the chief Compliance Officer relativeto presentations and briefing of the Board of DirectorsWorks with upper management in planning and organization of newservice areas and acquisitions of service with the financial department to optimize Reimbursement whilemaintaining proper Compliance special projects as , Skills, Abilities and Personal Characteristics:Extensive knowledge of various Compliance rules and regulations in thecoding, Billing and Reimbursement knowledge of the various sources and resources for informationat the federal, state and local level in the Compliance knowledge of the various payment systems including DRGs,APCs/APGs, RBRVS, RUGs-III and various managed care and knowledge of the various coding systems used by hospitals andphysicians including CPT, HCPCS, and of the charge master, its use, design, revenue center codes,relationship to CPT/HCPCS coding and overall impact on the coding .

5 Billing and Reimbursement of computer hardware and software its use, function anddesign relative to coding , Billing and knowledge of computer software for both prospective andretrospective review of coding , Billing and Reimbursement of statistics and the process for developing audit sample sizesand selection of cases for of the auditing process including various techniques relativeto auditing and problem Compliance OfficerApex Medical Center1999 Page - 3 -Knowledge of team dynamics and the process of building overall understanding of financial management and reporting in overall knowledge of the functions and activities of hospitals andmedical to participate with upper management in a decision support modethrough the development of appropriate management of the charge development

6 Process and the interrelationshipof cost accounting, cost management and related to effectively work with and coordinate the activities of to work with outside auditors relative to formal Compliance and skill to influence personnel through a matrix organization asopposed to line management to develop and lead teams toward stated objectives and in using personal computers for financial analysis (spreadsheets),data base development and report and skill in using personal computers for electronic mailcommunications and Internet access along with internal in performing research with bibliographic data bases and Internetaccess to associated information in networking both directly through colleagues and professionalorganizations along with the ability to utilize networking capabilitiesthrough Internet news groups and list communication skills for training and working with personnelin sometimes tense Background and Certifications.

7 Masters Degree in Healthcare Administration or Business Administrationis highly certification in risk management and/or health carecompliance highly to ten years progressive experience in financial management,information systems and/or health information management is applicable certifications provided by the ACHE, HFMA, AHIMA,AGPAM and/or associated organizations are To: chief Compliance Compliance OfficerApex Medical Center1999 Page - 4 -Subordinate Personnel:Subordinate staff is provided as needed and/or may be provided on aspecial project : This is a highly responsible position that requires bothquantitative and interpersonal skills.