Compliance Partner

BJC HealthCare; St. Louis (MO); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Medical, dental, vision

Tuition Assistance

401(k) with match

Paid time off

Job summary

BJC HealthCare in Missouri seeks a Compliance Partner to support the annual Corporate Compliance Workplan, educating departments under review by government auditors. The role requires educating staff on federal/state regulations and executing audit procedures to ensure proper billing and compliance.

The position involves preparing action plans, staying current on regulations, and conducting post-payment denial appeals, with a focus on risk mitigation and workflow improvement.

Qualifications

• Regulatory compliance knowledge
• Healthcare auditing experience
• Education program development

Responsibilities

• Conducts audits of medical records and healthcare claims.
• Maintains knowledge of federal and state billing, coding and medical necessity coverage.
• Designs and implements education programs to improve compliance outcomes.
• Identifies risks and recommends process improvements and controls.
• Conducts post-payment denials appeals.

Job description

Additional Information About the Role

Great opportunity for an experienced coder who is looking to grow in their career.

Responsibilities include writing appeals and audits.

Remote opportunity, should reside in the Greater St. Louis area.

Overview

BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and southeast Missouri regions. With net revenues of $6.3billion and more than 30,000 employees, BJC serves patients and their families in urban, suburban and rural communities through its 14 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice.

BJC is the largest provider of charity care, unreimbursed care and community benefits in the state of Missouri. BJC and its hospitals and health service organizations provide $785.9 million annually in community benefit. That includes $410.6 million in charity care and other financial assistance to patients to ensure medical care regardless of their ability to pay. In addition, BJC provides additional community benefits through commitments to research, emergency preparedness, regional health care safety net services, health literacy, community outreach and community health programs and regional economic development.

BJC’s patients have access to the latest advances in medical science and technology through a formal affiliation between Barnes-Jewish Hospital and St. Louis Children’s Hospital with the renowned Washington University School of Medicine, which consistently ranks among the top medical schools in the country.

Preferred Qualifications

Role Purpose

The Compliance Partner supports the yearly Corporate Compliance Workplan and serves as a resource to departments under review by government auditors including but not limited to Medicare Audit Contractors, Supplemental Review Medical Contractors and the Office of Inspector General. This individual would be responsible to educate, promote and reinforce compliance requirements with federal and state regulations.

Responsibilities

• Conducts audit of medical records and healthcare claims. This includes but not limited to review of the medical record, assessment of the documentation and charging to ensure departments are meeting billing, coding and regulatory requirements in accordance with federal and state regulations. This includes coordinating the development of departmental action plans.
• Maintains current knowledge of federal and state billing, coding and medical necessity coverage requirements.
• Designs, develops, and implements education programs for clients and staff members in the organization to improve compliance outcomes using available regulatory guidance and resources.
• Identifies potential risk, tracts issues, and recommends opportunities for continued process improvement and controls or other risk mitigation strategies.
• Conducts appeals for post-payment denials.

Minimum Requirements

Education

• Associate or Trade School Equi

Experience

• 10+ years

Licenses & Certifications

• RN
• RHIA/RHIT

Preferred Requirements

Education

• Bachelor's Degree

Licenses & Certifications

• CHC
• Registered Health Info Tech

Benefits and Legal Statement

BJC Total Rewards

At BJC we’re committed to providing you and your family with benefits and resources to help you manage your physical, emotional, social and financial well-being.

• Comprehensive medical, dental, vison, life insurance, and legal services available first day of the month after hire date
• Disability insurance* paid for by BJC
• Annual 4% BJC Automatic Retirement Contribution
• 401(k) plan with BJC match
• Tuition Assistance available on first day
• BJC Institute for Learning and Development
• Health Care and Dependent Care Flexible Spending Accounts
• Paid Time Off benefit combines vacation, sick days, holidays and personal time
• Adoption assistance

To learn more, go to our Benefits Summary.

*Not all benefits apply to all jobs

The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job. Equal Opportunity Employer