UCSD Layoff from Career Appointment: Apply by 10/18/2019 for consideration with preference for rehire. All layoff applicants should contact their Employment Advisor.
Special Selection Applicants: Apply by 10/30/2019. Eligible Special Selection clients should contact their Disability Counselor for assistance.
Under the direct supervision of the Billing and Coding Compliance Manager, and indirect supervision of the Associate Director of Billing and Coding Compliance, conduct research and detailed analytical reviews to determine the accuracy of HCFA 1500 claims by evaluating medical record documentation and professional claims for compliance with CPT, HCPCS, ICD-10 codes, and modifiers assignment. Independently analyze and communicate Federal and State regulations related to inpatient and outpatient professional billing requirements. Analyze and evaluate the accuracy of the billing process and conduct strategic risk assessment in order to ensure compliance.
Responsible for communicating UCSD Health's coding compliance standards and procedures, and for providing guidance and clarification related to coding questions to support accurate billing – to employees and to authorized representatives of UCSD Health's billing agents. Serve as a subject expert to the Rev Cycle Coding team on complex billing situations and provide guidance on compliance related matters such as laws, regulations and programs. Perform and analyze data/reports from compliance monitoring activities to identify trends, issues, and risk areas. Advise on issues relating to regulatory matters.
Work cross functionally with the Provider Educator team, revenue cycle and health information to proactively identify risks and respond to identified issues. Assist with coordination of responses to and resolutions of external investigations and audits. Responsible for monitoring billing, coding and related claims submission changes and updates from the Centers for Medicare and Medicaid Services (CMS), Medicare Administrative Contractor (MAC), Beneficiary and Family-Centered Care (BFCC) QIO, Medi-Cal and other related government entities. Develop presentations, audit summaries and process improvement plans. Perform other related duties as assigned.
Bachelor's Degree in related area; and/or equivalent combination of experience/training.
A minimum of three (3+) or more years of relevant experience.
Demonstrated knowledge and experience reviewing professional fee and hospital (facility) codes and claims.
Excellent, fast accurate computer skills using Microsoft Office applications. (Excel, Word, Powerpoint).
Experience and proven success in federal and state laws pertaining to privacy and information security (including HIPAA, the Information Practices Act, and Confidentiality of Medical Information Act) and medical center policies.
Knowledge and experience of CPT/ICD-10/APC validation process.
Current coding credentials (CPC, CCS), or health information professional (RHIT, RHIA) from a nationally recognized program (AHIMA, AAPC).
Certified Professional Medical Auditor (CPMA).
Certified in Healthcare Compliance (CHC).
Demonstrated in-depth knowledge and ability to conduct comprehensive review of patient records for appropriate medical record documentation of CPT/ICD-10/HCC Coding, APC and DRG assignment.
Must be able to work various hours and locations based on business needs.
Employment is subject to a criminal background check and pre-employment physical.
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