Healthcare Compliance Specialist

2 days ago

Oakland, California, United States Alameda Health System Full time

We are seeking a skilled Healthcare Compliance Specialist to join our team at Alameda Health System. In this role, you will play a critical part in ensuring the accuracy and quality of clinical documentation, while also educating healthcare providers on compliance-related topics.

As a key member of our Revenue Cycle department, you will work closely with various stakeholders to develop and implement policies, guidelines, and educational materials related to medical necessity, coding, and billing. Your expertise in analyzing risks and identifying potential areas for improvement will be invaluable in helping us optimize our reimbursement processes.

Some of your key responsibilities will include:

  • Analyzing billing and coding rules and regulations, as well as identifying potential risk areas through data analysis
  • Evaluating the quality of clinical documentation and providing feedback to physicians to ensure accurate coding
  • Partnering with other departments to develop standardized documentation, coding, and billing policies and guidelines
  • Performing coding audits, investigations, and inquiries as needed, and preparing summary reports for key stakeholders

To be successful in this role, you should have a strong understanding of coding principles, including CPT-4, HCPCS, ICD-10-CM/PCS, and Medicare conditions of payment. You should also have excellent analytical and communication skills, as well as the ability to work effectively in a fast-paced environment.

In terms of qualifications, we are looking for candidates with a minimum of 5 years of direct coding, compliance, and auditing experience. A Bachelor's degree in a related field is preferred, as is certification as an AAPC Certified Professional Coder (CPC) or AHIMA's Certified Coding Specialist (CCS-P). However, we encourage all qualified applicants to apply.

This is a full-time position, and we offer a competitive salary of $85,000 per year, commensurate with experience. We also offer a comprehensive benefits package, including medical, dental, and vision coverage, as well as a 401(k) plan and generous paid time off.

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