COMPLIANCE SPECIALIST

Duke; Durham (NC); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Equal Opportunity Employer

Community-focused environment

Diversity and inclusion initiatives

Job summary

A leading health system is looking for a Compliance Specialist in Durham, NC. This role involves implementing compliance programs and educating providers on government regulations, especially in the arena of coding and billing. Candidates should possess a Bachelor's degree and extensive experience in compliance and auditing with relevant certifications like CPC and RHIA or RHIT. This position is critical to maintaining the compliance integrity of healthcare operations.

Qualifications

• A Bachelor's degree is required to develop strong organizational, analytical, and communication skills.
• Technical coding requires two years of experience with DRGs and APR-DRGs.
• Four years of experience in compliance, coding, and auditing is necessary.

Responsibilities

• Implement compliance programs to reduce legal and financial risk.
• Educate providers on compliance with government regulations.
• Conduct routine internal audits of provider documentation.
• Collaborate with internal staff to improve documentation and coding practices.

Skills

Analytical skills

Communication skills

Compliance knowledge

Coding principles

Education

Bachelor's degree

Tools

DRGs and APR-DRGs

CPC

RHIA

RHIT

CCS

Job description

At Duke Health, we are 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.

Pursue your passion for caring with the Patient Revenue Management Organization, which is the 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 for Duke Health.

Occ Summary

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.

Work Performed

Educate providers regarding compliance with government regulations with special attention to Center for Medicare and Medicaid guidelines as they pertain to academic medical centers, HIPAA, and fraud and abuse with periodic updates. Assist in performing an analysis of current situations and recommend priorities and goals for future clinic needs. Identify coding and billing risk areas, conduct focused reviews, and implement corrective action as needed. Conduct routine internal audits of provider documentation on a timely basis. Collaborate with physicians and internal staff in the development of improved capabilities in the areas of documentation, coding, and compliance. 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 clinical goals and objectives. Respond promptly to external and internal concerns; implementing corrective actions as appropriate. Communicate with Medicare/Medicaid carriers and third‑party payers regarding policies and procedures. Promote compliance initiatives with clinical faculty 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 DRGs and APR‑DRGs are 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 is preferred. CPC or CCS or RHIT or RHIA or CPMA is required.

Degrees, Licensures, Certifications

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 DRGs and APR‑DRGs are 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 is preferred. CPC or CCS or RHIT or RHIA or CPMA is required.

Duke is an 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 (including pregnancy and pregnancy‑related conditions), sexual orientation or military 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 essential job 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.

Nearest Major Market: Durham
Nearest Secondary Market: Raleigh

Read more about Duke’s commitment to affirmative action and nondiscrimination at hr.duke.edu/eeo.