Certification Required or Eligible
5 years of experience required
Riverside Health System is seeking a full time Compliance Analyst to join the team.
Job Summary: Primary responsibility is to perform risk adjustment audits, clinical chart reviews, coding analyses, charge/reimbursement analyses, medical records reviews, and educate provider personnel on coding methodologies that will result in improved accuracy by following RMG compliance standards for commercial and government payors. This position also serves as the point of coordination within the department for the review and root cause analysis of charge review work queues, coding denial volumes, and coding trends. Responsible for identifying and reporting obstacles, patterns, and variations as well as resolutions in a timely, clear and concise manner. Demonstrates strong problem solving skills, and an aptitude for learning. Performs other duties as assigned.
Education: High school diploma or equivalent preferred.
Certification: CPC, CPC-H, or CCS-P required.
Experience: 5+ years of experience with government and commercial billing and collections, coding experience, and customer service. Auditing experience in either a provider or payor environment required. Knowledge of governmental reimbursement methodologies; ability to research and analyze medical data and information; experience in qualitative and quantitative medical record reviews; ability to work with providers and other health care professionals; understand the intent of HIPAA and all other privacy laws; frequent travel to various clinical locations. Knowledge of GE Centricity, Soarian and GM Practice Management and Epic a plus.
Hours: Monday-Friday, 8:00am-4:30pm