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Compliance Education Specialist

4 months ago

Baltimore, United States Johns Hopkins University Full time

We are seeking a **_Compliance Education Specialist_** who will plan, manage and ensure the development and delivery of billing compliance education in accordance with the Office of Compliance Professional Fee Services Compliance Plan. Provides on-going training and support to physicians, non-physician practitioners, professional-fee billing staff, clinic staff, administrators, compliance auditors and other affected personnel on documentation and billing requirements. Use auditing and analysis techniques, determines the adequacy of medical records documentation, coding and billing for all providers across all clinical specialties. Routinely analyzes the compliance audit plan and risk-based audit results for assessment of training and education effectiveness. Oversees compliance education activities in accordance with the Professional-Fee Services Compliance Plan. Ensures real-time monitoring of regulatory based compliance education. Works in close collaboration with the clinical departments, revenue cycles, compliance, and others. Prepares reports for the Senior Director, Director, and clinical department leadership regarding the status or results of reviews and/or education and training.

**Specific Duties & Responsibilities**
- Assumes responsibility for developing and maintaining JHM Billing Compliance course training curricula content in accordance with CPT coding standards and Federal and State regulatory guidelines.
- Assumes responsibility for designing and delivering training, using a variety of teaching methods (i.e. on-line training, case simulation, and other emerging educational technologies) and managing workflows for preparing training materials, scheduling, and tracking attendance.
- Conducts training sessions for clinicians, professional fee coders and others on a regularly scheduled or ad hoc basis.
- Partners with peers to ensure compliance staff are trained on documentation, auditing, and education.
- Identifies training and education needs through compliance audit results prepared and reported.
- Prepares and revises as needed a Compliance training manual or job aides for routine and special training programs.
- Serves as Lead for compliance training and prepares and/or reviews all billing compliance training materials developed by clinical departments, revenue cycle, and others.
- Serves as a primary resource for documentation, coding, and regulatory guidelines.
- Performs independent audits on the adequacy of medical record documentation for professional fee charges by ensuring compliance with government regulatory guidelines (i.e. Centers for Medicare & Medicaid Services
- CMS conditions of payment) and CPT coding standards.
- Performs as necessary, a second-level review of audit work completed by Auditors and Sr. Auditors/Trainers for quality assurance.
- Provides feedback to clinicians and/or coders on the results of medical record documentation reviews and gives targeted training as needed.
- Identifies trends in billing, coding and documentation errors that pose a compliance risk and recommends corrective action plans.
- Provides guidance and tools to assist departments and clinicians in developing corrective action plans to improve documentation practices, address compliance problems, or improve professional fee billing activities. Monitors implementation of corrective action plans.
- Researches and answers billing and documentation questions or problems received from faculty, other physicians, advanced practice practitioners, departments, coders, billing staff, and others to ensure compliance with specific payer regulations and Johns Hopkins Medicine policies and procedures.
- Regularly monitors billing problems and/or errors identified by each departments' professional fee billing office as potentially impacting compliance.
- Research and assists in the development of medical record documentation standards and requirements related to clinical services billing.
- Keeps current with third party regulations with emphasis on Medicare and Medicaid billing, teaching physician regulations, Current Procedural Terminology, ICD-10-CM Coding, and professional fee billing.
- Performs other compliance related activities as necessary.
- Scope of Responsibility_
- Knows the formal and informal departmental goals, standards, policies and procedures which include familiarity of other departments within the school/division. Is sensitive to the relationship of both people and functions within the department, the Clinical Practice Association and JHHS Compliance Office.
- Decision Making _
- On a regular and continual basis, exercises administrative judgment and assumes responsibility for decisions, consequences, and results having an impact on people, costs, and/or equality of service within the functional area.
- Routinely handles confidential patient information and sensitive financial information.
- Authority_
- Compliance Specialists may be asked to assist with training new staff or correctin