Billing Compliance Analyst Team Lead | Phys Billing Compliance - Hybrid | Days | Full Time

Overview

Job Duties

Under limited supervision, the Lead Physician Billing Compliance Analyst (Lead) will perform physician

coding/documentation reviews for providers of the University of Florida Jacksonville Physicians Group (UFJPI). Audit focus

will be on physician/non-physician practitioner coding and chart documentation to include review of E&M, CPT-4, ICD-10,

Level II HCPCs, Teaching Physician guidelines and carrier specific policies. The Lead will prepare and present accurate

reports of audit findings to appropriate personnel. The Lead will coordinate with various UFJPI representatives to ensure

that any resulting refunds are processed and educational needs are addressed. The Lead will assist the Manager with

monitoring and recording of productivity and quality of staff and will train staff on job duties and work flow processes. The

Lead will ensure all job duties are covered when personnel are on vacation or ill. The Lead will handle routine personnel

issues and act as the liaison between the Manager and Office of Compliance (OOC) staff.

Responsibilities

Essential Functions

• Perform audit reviews of medical providers of the UFJPI within designated timeframes.
• Identify ongoing problems in audit process and notify manager when issues surface.
• Audit chart documentation for accurate coding and to verify that chart documentation supports services billed.
• Audit chart documentation for compliance with E&M, CPT procedure coding, ICD-10-CM diagnosis coding, Teaching Physician guidelines, payer specific polices and regulatory requirements.
• Prepare accurate audit reports that include summary spreadsheets of audit findings.
• Perform analysis of audit findings and summarize by individual records for placement in the OOC central database. Present audit results to appropriate faculty and billing personnel.
• Identify remedial training needs through audit process and if necessary conduct remedial training with provider or billing staff.
• Identify, locate and obtain medical record documentation necessary to accurately complete audits.
• Perform quality assessments on work product of Analysts and Research Assistants in accordance with departmental policies and procedures.
• Assist in the development of policies and procedures to ensure work is performed and completed in accordance with the University of Florida College of Medicine Billing Compliance Plan
• All other duties as assigned
• Travel up to 10%

Qualifications

Experience Requirements

2 years Medical billing required

5 years Medical coding (procedural and diagnosis) for multi-specialty providers required

4 years Medicare, Medicaid, and Tricare payment and reimbursement rules required

4 years Medical record chart auditing for professional billing required

1 year Supervisory or project management required

1 year medical management information systems (EPIC preferred) required

1 year Auditing software applications (e.g MDaudit, Compliance Risk Analyzer) preferred

Education

High School Diploma or GED equivalent required

Associates Business or Health care related field preferred

Certificate/Licensure

Certified Coding Specialist required or at time of hire

Certified Coding Specialist - Physician Based

(CCS-P) - AHIMA

required or at time of hire

Certified Professional Coder (CPC) required or at time of hire

Certified Professional Medical Auditor (CPMA) required at time of hire

UFJPI is an Equal Opportunity Employer and Drug Free Workplace