Physician Billing Compliance Analyst | Downtown / Remote| Days

Overview

Job Duties

Under limited supervision, the Physician Billing Compliance Analyst ("Analyst") will perform physician coding / documentation audits for providers of the University of Florida College of Medicine - Jacksonville ("COM-Jax") and the University of Florida Jacksonville Physicians Group ("UFJPI"). Analyst will also perform abbreviated reviews on newly hired providers' documentation outside of the regular compliance audit cycle. Audit focus will be on physician / advanced practice professional coding and chart documentation to include review of E&M, CPT, ICD-10-CM, HCPCS Level II, teaching physician guidelines and carrier specific policies. The Analyst will utilize medical management systems as well as auditing software applications to perform reviews. The Analyst will prepare and present accurate reports of audit findings to appropriate personnel. The Analyst will coordinate with various COM-Jax and UFJPI representatives to process any resulting refunds and address educational needs from the audit findings.

Responsibilities

Essential Functions

• Within designated timeframes and by utilizing medical management systems, audit chart documentation and professional billing for compliance with E&M, CPT procedure coding, ICD-10-CM diagnosis coding, teaching physician guidelines, payer specific polices and regulatory requirements.
• Perform analysis of audit findings and summarize for placement in the Physician Billing Compliance Services ("PBC") central database.
• Participate in opening and closing audit conferences with representatives of the COM-Jax and UFJPI.
• Identify remedial training needs through audit process and if necessary, conduct remedial training with providers and / or UFJPI billing staff.
• Assist in the development of policies and procedures to complete work in accordance with the COM - Jax Billing Compliance Plan.
• Problem solve issues identified during the audit process.
• Assist with creation and performance of audits through the utilization of various auditing software programs.
• Assist Manager and Director of PBC with research and analysis for special projects and other duties as assigned.
• All other duties as assigned

Qualifications

Experience Requirements

2 years Medical billing required

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

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

3 years Medical record chart auditing for professional billing required

1 year Medical management information systems (EPIC preferred) required

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

Education Requirements

High School Diploma or GED required

Associates Business or health care industry related field preferred

Certification / Licensure / Training

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 within 6 months

UFJPI is an Equal Opportunity Employer and Drug Free Workplace