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Healthcare Compliance Specialist

2 months ago

Oakland, California, United States Alameda Health System Full time
Job Summary

We are seeking a skilled Healthcare Compliance Specialist to join our team at Alameda Health System. As a key member of our team, you will be responsible for ensuring compliance with regulatory requirements and industry standards in medical record documentation and coding.

Key Responsibilities
  • Analyze and assess risks related to billing and coding rules and regulations, identifying potential areas of non-compliance.
  • Evaluate the quality of clinical documentation and monitor its appropriateness, providing feedback to physicians to ensure accurate coding and optimal reimbursement.
  • Partner with various departments to develop and implement standardized documentation, medical necessity, coding, and billing policies and guidelines.
  • Perform inpatient and outpatient coding audits, investigations, and reviews, preparing summary reports and communicating findings to stakeholders.
  • Review electronic health records to identify potential coding and billing compliance issues, ensuring adherence to CPT-4, HCPCS, ICD-10-CM/PCS coding rules, and other regulatory requirements.
Requirements

To be successful in this role, you will need:

  • A minimum of 5 years of direct coding, compliance, and auditing experience, with a strong understanding of E/M coding rules, CPT-4, HCPCS, and ICD-10-CM/PCS.
  • A degree in a related field, such as healthcare administration or health information management.
  • Professional certifications, such as AAPC Certified Professional Coder (CPC) or AHIMA's Certified Coding Specialist (CCS-P).
What We Offer

As a valued member of our team, you will have the opportunity to work with a talented group of professionals, contribute to the development of our compliance program, and make a meaningful impact on the quality of patient care.