What are the responsibilities and job description for the Compliance Specialist position at Duke?
At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.
About Duke Health's Patient Revenue Management Organization
Pursue your passion for caring with the Patient Revenue Management Organization, which is Duke Health's fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions.
Implement and maintain Compliance programs in accordance with the Office of Inspector General's work plan, to reduce institutional and individual provider legal and financial risk through education and internal audits.
Duties and Responsibilities of this Level:
40% Education & Training
- Educate providers, clinical, and non-clinical staff regarding compliance with government regulations with special attention to CMS guidelines as they pertain to academic medical centers, HIPAA, and Fraud and Abuse with periodic updates
- Provide onboarding training to non-clinical staff related to policies and procedures in HIM related functions in accordance with Federal and State regulations and guidance
- Complete training material updates for new hires along with auditing new hire workloads at 100% within their probationary period for accuracy and compliance
- Serve as the preceptor for new hires providing ongoing and consistent onboarding support for new staff members and on call procedures along with re-education for existing team members on a rotational basis with Compliance Specialists.
- Monitor productivity standards for new hires, set progressive goals, and coordinate with unit Leadership for training coverage needs while conducting quality assessments for each new hire
- Conduct one on one sessions with new hires to discuss progress, answer questions, and review work where further direction or redirection may be required.
17% Compliance Audit/Analysis
- Assist in performing analysis through focused reviews of current processes to identify and recommend goals for future clinic needs, identifying coding and billing risk areas, legal medical record compliance risks, and implementing corrective action as needed
- Conduct random quality audits of existing budgeted staff members in addition to external audits of Patient Identity processes performed as required for HIM PIM internal/external controls
- Review errors identified through the issues forwarded through various sources (SRS, Maestro Care Chart Correction Request, email, etc.).
- Analyze errors identified through OER, QA, and these escalated pathways for entries to identify, recommend and implement training initiatives that indicate risk for OIG and OCR complaints
43% Internal Controls & Risk Response
Review internal controls, policies, and procedures to ensure compliance with appropriate University, State, and Federal guidelines and policies, sound business and finance practices, and overall organization and clinical goals and objectives. Review end to end process for assessment and internal controls and report to leadership per protocol providing review of error trends from both OERS and internal controls From end to end review, determine retraining needs for individuals and teams as it relates to incomplete or inappropriate processing errors related to patient’s right of access and/or the response to legal and regulatory requests processed according to law related to EHR content. Respond promptly to external and internal concerns; implementing corrective actions as appropriate Promote Compliance initiatives with clinical faculty, staff and administration Perform other related duties incidental to the work described herein
Minimum Qualifications
Education
Work requires organization, analytical and communication skills generally acquired through the completion of a Bachelor's degree program
Experience
Four years of administrative experience to acquire competence in applying compliance, coding and auditing principles as they relate to insurance billing, collections, consulting, and other revenue cycle related functions.
For technical coding, two of the four years of experience with DRG's and APR-DRG's is required. Experience in formal teaching of coding is preferred. RHIA or RHIT or CCS required.
For professional coding, specialty coding experience in surgical or E/M coding preferred. CPC or CCS or RHIT or RHIA or CPMA is required.
Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essentialjob functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.
