Director of Compliance Coding & Billing - Emory Healthcare

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Director, Compliance Coding and Billing Audit and Analysis reports to the Chief Compliance Officer of Emory Healthcare (CCO EHC) for the job responsibilities relating to Emory Healthcare Office of Compliance Programs.

• Manages, plans, organizes and completes the auditing activities required to comply with federal guidelines and other compliancerelated requirements.
• Plans, directs, evaluates, coordinates, and monitors activities and operations related to organizational regulatory compliance efforts pertaining to coding and billing audits for health care services including management of staff and assigned projects.
• Responsible for serving as the second line of defense ensuring that business units have established and implemented effective operational processes that impact the accuracy of hospital billing across the organization, including patient registration, ordering and scheduling of tests and services, as well as documentation and charge capture, including the assignment of codes.
• Performs risk analysis utilizing MDAudit tool as well as other methods to identify areas with greatest potential for non-compliance with governmental and internal requirements, and identifies lost revenue opportunities and any overpayments made due to errors in coding, insufficient medical record documentation, etc. 
• Assists in coordinating education with Director of Compliance Education to increase and strengthen health care providers' awareness and understanding of medical record documentation guidelines and coding principles.
• Provides specific guidance to ensure the organization abides by federal and state laws, regulations, and organizational policies hospital Inpatient and Outpatient (IP and OP) and professional coding and documentation 
• Works closely operational leadership to address any compliance-related deficiencies identified in processes, serving as a regulatory subject matter expert and advisor on complex hospital (IP and OP) and provider documentation, coding and billing matters.
• Assists the CCO EHC in assessing risk and developing an auditing plan to support the overall compliance plan.
• Develops and implements strategic goals and objectives for the audit and analysis team as it relates to both the department workplan as well as ongoing activities. 
• Works with operations leadership to perform comprehensive compliance audits as designed and directed via the Annual Compliance Work Plan.
• Maintains documentation of methods used and individuals involved in verifying compliance; documented identified issues (including method of intake), corrective actions taken, and improvements implemented.
• Establishes and implements best practices for audit working paper documentation, security, and retention.
• Provides oversight for the audit scope and objectives, and final audit reports.
• Consults with senior management and staff upon the conclusion of audits, both orally and in writing, to describe observations and recommend corrective action which will enhance compliance as well as coordinate any training needs associated with audit findings.
• Works with external auditors as needed, to pull audit data and to finalize audit finding reports following the standard operating procedures of the Office of Compliance Programs.
• Develops policies and procedures for auditing medical records for compliance with required documentation guidelines including completeness and accuracy of coding.
• Makes recommendations which are consistent with regulatory requirements for coding/ documentation, to assure that services rendered are documented and bills are submitted appropriately as an integral part of Emory Healthcare's overall Compliance Program.
• Serves as a subject matter expert regarding provider coding and documentation standards, guidelines, and regulatory requirements across the organization, including coding, billing, CMS and other regulatory and/or payer changes. 
• Manages and maintains a regular schedule of auditing activities, involving department directors and clinical staff as needed to attain effectiveness of the overall Compliance Program.
• Oversees focused, technical education for physicians and other clinical staff to promote knowledge regarding medical record documentation guidelines, billing rules and related standards in collaboration with Revenue Cycle coding educators.
• Works closely with leaders in Revenue Cycle to coordinate training and education as well as applicable audits and follow up. 
• Regularly assists in the development and presentation of programs to staff to accomplish educational objectives as set forth in the Compliance Program. 
• Demonstrates a knowledge and understanding of organizational policies and procedures, billing and reimbursement requirements and other regulations that affect operations.
• Maintains a library of appropriate reference material that will facilitate the understanding and compliance of federal coding documentation requirements.
• Participates in outside healthcare compliance organizations to stay abreast of compliance developments and best practices within the industry.
• Provides research and advice for billing compliance initiatives.
• Enhances professional growth and development through in-service meetings, education programs, conferences, etc. 
• Ensures confidentiality of all audits and reports generated by this department, working within established policies for protection of data. 
• As requested, attends Operating Units meetings to discuss risk assessment or auditing processes and results.
• Collaborates with the team and departments to prepare materials and updates to the organizational Governance Committees including but not limited to the Management Compliance Committee and Audit and Compliance Committee. 
• Works collaboratively with the Internal Audit department of Emory University in performing risk assessments, developing audit programs, conducting the annual Enterprise Risk Management (ERM) process. 
• Assists the CCO EHC with the preparation of the annual compliance audit plan ensuring that compliance risks are adequately addressed. -
• Oversees staff that reviews billing compliance related to clinical trials.
• Interacts with all levels of management within the Health System. Responsible for guiding and managing Revenue Compliance Auditor /Educator(s), including but not limited to hiring, training, development and performance management. Engage staff through routine communication to promote a team environment and improve workflow/communication and on the development of best practice techniques.

EDUCATION:

• A bachelors degree in a business, science, accounting, medical, legal, or related field. Masters degree preferred.
• Certification in healthcare compliance or another comparable compliance certification from a recognized industry professional association with a focus on regulatory compliance, auditing, monitoring, etc.

EXPERIENCE:

• Minimum of seven (7) years experience in a healthcare setting with experience performing medical center billing compliance, medical record audits for clinical documentation, charge and reimbursement accuracy.
• Three years of related regulatory compliance experience.
• Two years supervisory/ managerial experience. Knowledge of medical records/coding/billing processes relating to Clinical Trials and knowledge of regulations pertaining to medical billing. Knowledge of coding with CPT and ICD -9-CM, health care management in terms of financial and billing concepts, health care reimbursement, and managed care issues. Experience in a supervisory/management position.

KNOWLEDGE, SKILLS, ABILITIES:

• Strong written and oral communication skills.
• Strong analytical and problem-solving skills.
• Proficiency in working with Microsoft Office products and other healthcare applications.
• Proven ability to manage multiple projects and deadlines.
• Strong people management skills.
• May be required to travel to various operating units locations.

POSITION: Hybrid, in office 2-3 days per week.

Supporting a diverse, equitable and inclusive culture.  Emory Healthcare (EHC) is dedicated to providing equal opportunities and access to all individuals regardless of race, color, religion, ethnic or national origin, gender, genetic information, age, disability, sexual orientation, gender identity, gender expression and/or veteran's status. EHC does not discriminate on the basis of any factor stated above or prohibited under applicable law. EHC respects, values, and celebrates the unique perspectives and backgrounds of all individuals. EHC aspires to create an environment of collaboration and true belonging for all our patients and team members.  Emory Healthcare (EHC) is committed to achieving a diverse workforce through equal opportunity and nondiscrimination policy in all aspects of employment including recruitment, hiring, promotions, transfers, discipline, terminations, wage and salary administration, benefits, and training.

ACCOMODATIONS: EHC will provide reasonable accommodations to qualified individuals with disabilities upon request. To request this document in an alternate format or to request a reasonable accommodation, please contact the Office of Diversity, Equity, and Inclusion.”

PHYSICAL REQUIREMENTS: (Medium-Heavy) 36-75 lbs., 0-33% of the work day (occasionally); 20-35 lbs., 34-66% of the workday; (frequently); 10-20 lbs., 67-100% of the workday (constantly); Lifting 75 lbs. max; Carrying of objects up to 35 lbs.; Occasional to frequent standing & walking; Occasional sitting; Close eye work (computers, typing, reading, writing); Physical demands may vary depending on assigned work area and work tasks.

ENVIRONMENTAL FACTORS: Factors affecting environment conditions may vary depending on the assigned work area and tasks. Environmental exposures include, but are not limited to: Blood-borne pathogen exposure; Bio-hazardous waste Chemicals/gases/fumes/vapors; Communicable diseases; Electrical shock; Floor Surfaces; Hot/Cold Temperatures; Indoor/Outdoor conditions; Latex; Lighting; Patient care/handling injuries; Radiation; Shift work; Travel may be required; Use of personal protective equipment, including respirators; environmental conditions may vary depending on assigned work area and work tasks.