Supervisor of Compliance and Documentation

1. Position Title: Supervisor of Compliance and Documentation Audits

 

2. SUMMARY OF DUTIES:
1. Adheres to the policies and procedures regarding the accumulation and processing of data.
2. The functional requirements of the Compliance and Documentation Audit section as defined by the Manager include: assuring that all charge capturing procedures, inpatient and outpatient, are consistent with established protocols and applicable third party regulations and requirements, monitoring of regulatory changes in third party documentation and/or coding requirements, and conduct routine education programs for staff and physicians to communicate findings from quality reviews.
3. Specific responsibilities are as follows:
1. Provide staff support for the creation, maintenance and ongoing operation of an efficient and accurate system of reimbursement and documentation, compliance review and quality assurance.
2. Monitors the billing protocols and procedures to assure compliance with all regulatory and governmental requirements.
3. Works with the CBO staff to assure that reimbursement is commensurate with the level of coding provided.
4. Supervise or conduct all inpatient and outpatient chart reviews to ensure compliance with coding and documentation guidelines and governmental requirements.
5. Works with the Manager to provide physician review and education resulting from the quality assurance chart audits.
6. Works with the Clinical Reimbursement section to assure that all services identified in the patient’s chart and other relevant documents which are to be billed are adequately documented in accordance with IL-372 and/or any other regulatory mandates.
7. Develops and maintains a close working relationship with the clinicians and their staff to assure that as full an understanding of documentation and coding guidelines as possible is reached, resulting in the accurate representation of services provided.
8. Maintains working knowledge of all rules and regulations regarding billing and billing documentation for all contractual payers who utilize physician services.
9. Develops and implements reports as needed and requested by the Manager and/or Director to assist in the review and analysis of the documentation and coding patterns of physicians.
10. Assume all supervisory duties for staff in the Compliance and Documentation Audit section including, but not limited to, approving PTO, maintaining PTO/sick logs, performance reviews and counseling of employees, if needed.

 

3. Machines, Tools, Equipment Operated:

Telephone, copier, adding machine, IDX computer system terminal and IBM personal computer, including word processing and spreadsheet software.

 

4. Education and Training:

Bachelor’s Degree in health care field preferred. Knowledge of medical terminology, anatomy and physiology, pathophysiology, ICD-9-CM and CPT-4 coding classification systems, regulatory agency requirements, computer literacy and health care statistics computation required.

 

5. Experience

3+ years fee abstraction and/or billing experience with specific experience in coding and compliance review in a multi-specialty setting. Knowledge of computerized billing system required, IDX preferred. 2+ years supervisory experience preferred.

 

6. Initiative, Judgment and Creative Ability:

Proven analytical, investigative and organizational ability. Proven ability to work with minimal supervision at a high level of productivity. Must be able to communicate both verbally and in writing in a highly professional manner. Must be able to prioritize own work and proceed with a minimum of supervision. Confidential patient, financial and employee information must be protected according to institutional policy.

 

7. Mental, Visual and Hearing Demand:

Position requires close attention to detail and ability to handle multiple tasks simultaneously, telephone and face-to-face contact with other staff and external contacts, viewing a computer monitor and reading computer-printed reports, and ability to meet deadlines and work with frequent interruptions. Continuous attention to detail required. Must demonstrate flexibility and be able to function under pressure.

 

8. Reports and Records:

Access to highly confidential information and reports including utilization and reimbursement reports and patient charts.

 

9. Contacts:

Physicians, staff and other hospital and skilled nursing employees.

 

10. Comments:

Ability to work independently and as part of a team is critical. Must have excellent command of the English language. Must be able to make decisions based on sound judgment. Must be punctual and maintain an excellent attendance record. Ability to maintain professional attitude at all times. Incumbent must consistently adhere to department standards for professional office environment. Must be articulate, mature and highly organized.