Job Information
Johns Hopkins University Compliance Education Specialist in Baltimore, Maryland
We are seeking a Compliance Education Specialist who will plan, manage and ensure the development and delivery of billing compliance education in accordance with the Office of Compliance Professional Fee Services Compliance Plan. Provides on-going training and support to physicians, non-physician practitioners, professional-fee billing staff, clinic staff, administrators, compliance auditors and other affected personnel on documentation and billing requirements. Use auditing and analysis techniques, determines the adequacy of medical records documentation, coding and billing for all providers across all clinical specialties. Routinely analyzes the compliance audit plan and risk-based audit results for assessment of training and education effectiveness. Oversees compliance education activities in accordance with the Professional-Fee Services Compliance Plan. Ensures real-time monitoring of regulatory based compliance education. Works in close collaboration with the clinical departments, revenue cycles, compliance, and others. Prepares reports for the Senior Director, Director, and clinical department leadership regarding the status or results of reviews and/or education and training.
Specific Duties & Responsibilities
Assumes responsibility for developing and maintaining JHM Billing Compliance course training curricula content in accordance with CPT coding standards and Federal and State regulatory guidelines.
Assumes responsibility for designing and delivering training, using a variety of teaching methods (i.e. on-line training, case simulation, and other emerging educational technologies) and managing workflows for preparing training materials, scheduling, and tracking attendance.
Conducts training sessions for clinicians, professional fee coders and others on a regularly scheduled or ad hoc basis.
Partners with peers to ensure compliance staff are trained on documentation, auditing, and education.
Identifies training and education needs through compliance audit results prepared and reported.
Prepares and revises as needed a Compliance training manual or job aides for routine and special training programs.
Serves as Lead for compliance training and prepares and/or reviews all billing compliance training materials developed by clinical departments, revenue cycle, and others.
Serves as a primary resource for documentation, coding, and regulatory guidelines.
Performs independent audits on the adequacy of medical record documentation for professional fee charges by ensuring compliance with government regulatory guidelines (i.e. Centers for Medicare & Medicaid Services- CMS conditions of payment) and CPT coding standards.
Performs as necessary, a second-level review of audit work completed by Auditors and Sr. Auditors/Trainers for quality assurance.
Provides feedback to clinicians and/or coders on the results of medical record documentation reviews and gives targeted training as needed.
Identifies trends in billing, coding and documentation errors that pose a compliance risk and recommends corrective action plans.
Provides guidance and tools to assist departments and clinicians in developing corrective action plans to improve documentation practices, address compliance problems, or improve professional fee billing activities. Monitors implementation of corrective action plans.
Researches and answers billing and documentation questions or problems received from faculty, other physicians, advanced practice practitioners, departments, coders, billing staff, and others to ensure compliance with specific payer regulations and Johns Hopkins Medicine policies and procedures.
Regularly monitors billing problems and/or errors identified by each departments’ professional fee billing office as potentially impacting compliance.
Research and assists in the development of medical record documentation standards and requirements related to clinical services billing.
Keeps current with third party regulations with emphasis on Medicare and Medicaid billing, teaching physician regulations, Current Procedural Terminology, ICD-10-CM Coding, and professional fee billing.
Performs other compliance related activities as necessary.
Scope of Responsibility
Knows the formal and informal departmental goals, standards, policies and procedures which include familiarity of other departments within the school/division.
Is sensitive to the relationship of both people and functions within the department, the Clinical Practice Association and JHHS Compliance Office.
Decision Making
On a regular and continual basis, exercises administrative judgment and assumes responsibility for decisions, consequences, and results having an impact on people, costs, and/or equality of service within the functional area.
Routinely handles confidential patient information and sensitive financial information.
Authority
Compliance Specialists may be asked to assist with training new staff or correcting the work of others.
Identifies and suggests process and operational improvements.
Communications
- Exchanges non-routine information using tact and persuasion as appropriate requiring good oral and written communication skills.
Special Knowledge, Skills & Abilities
Requires a detail-oriented individual with the ability to handle a high volume of multiple tasks and follow through to completion.
Must be able to learn quickly and work independently to address a variety of complex issues.
Must be flexible to adjust to the development and refinement of new processes and procedures.
CPT and ICD-10 coding required, including coding from clinical documentation or auditing the coding of others.
Extensive knowledge of Medicare regulations regarding teaching physicians, documentation guidelines, and other federal and state laws and regulations concerning clinical documentation, coding, and reimbursement required.
Knowledge of related clinical and business practices, policies, and procedures for billing and collection of professional fee services, and audit processes preferred.
Communication, analytical and organizational skills are essential.
Proficient in Microsoft Word applications including Excel, Word, PowerPoint, Outlook or equivalent e-mail, and internet usage. Experience with Epic and other clinical information systems preferred. Must be self-motivated and comfortable working independently, as a team leader and as a team member.
*This description is a general statement of required major duties and responsibilities performed on a regular and continuous basis. It does not exclude other duties as assigned.
Minimum Qualifications
Bachelor's Degree in health care-related or business-related field.
A minimum of one professional coding certification (CCS-P, CPC, RHIA or RHIT) required by start date.
Five years of auditing/billing compliance.
Demonstrated training or teaching experience.
Preferred Qualifications
Additional coding certifications.
Seven (7) years of compliance education experience.
Classified Title: Sr. Billing Compliance Auditor
Job Posting Title (Working Title): Compliance Education Specialist
Role/Level/Range: ATP/04/PE
Starting Salary Range: $72,600 - $127,000 Annually ($99,800 targeted; Commensurate with experience)
Employee group: Full Time
Schedule: M-F 8:30A-5PM
Exempt Status: Exempt
Location: Hybrid/Mount Washington Campus
Department name: Office of Compliance: Prof Fee Services
Personnel area: School of Medicine
Equal Opportunity Employer:
Johns Hopkins University is an equal opportunity employer and does not discriminate on the basis of race, color, gender, religion, age, sexual orientation, national or ethnic origin, disability, marital status, veteran status, or any other occupationally irrelevant criteria. The university promotes affirmative action for minorities, women, disabled persons, and veterans.