Physician Practice Compliance Specialist

Hackensack Meridian Health Inc.; Iselin (PA); Hybrid; USD 95,000 - 125,000; Full time

Job summary

Hackensack Meridian Health is seeking a Physician Practice Compliance Specialist to assure ongoing compliance within our physician enterprise and affiliated services. The role focuses on documentation, coding accuracy, and regulatory requirements across Medicare, Medicaid, and state programs.

The position is hybrid and requires a BA/BS, 5+ years coding/audit experience, and a CCS or CPC credential. Epic Ambulatory proficiency and strong regulatory knowledge are preferred.

Qualifications

• Minimum of 5 years coding and/or audit experience in a hospital, consulting firm or practice management setting.
• Proficiency with ICD-10 and CPT-4 methodologies.
• Proficiency with physician documentation and reimbursement methodologies.
• Proficiency in the use of an electronic health record, preferably Epic Ambulatory.

Responsibilities

• Assure ongoing compliance by actively participating in the Compliance Program for Hackensack Meridian Health and affiliated services.
• Proactively assess changes in the regulatory environment; research, investigate and respond to issues related to documentation, coding and licensure.
• Ensure accurate documentation of professional services provided throughout the physician enterprise; review claims and assess adequacy; recommend enhancements to policies, procedures and internal controls for documentation and billing to meet payer and regulatory requirements.

Skills

Coding experience

Audit experience

Documentation accuracy

Regulatory knowledge

Education

BA/BS

Tools

Epic Ambulatory

Job description

Our team members are the heart of what makes us better.

At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community.

Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

The Physician Practice Compliance Specialist is responsible for assuring on-going compliance by actively participating in the Compliance Program for Hackensack Meridian Health and for affiliated services. The Physician Prac Compliance Spec assures the integrity of the physician practice regulatory environment in consultation with the Director of Corporate Compliance. This position proactively assesses changes in the regulatory environment; researches, investigates and responds to issues related to documentation, coding and any required licensure. Ensures the accurate documentation of professional services provided throughout the physician enterprise. This position reviews claims, assesses adequacy and recommends enhancements to policies, procedures and internal controls for documentation and billing in order to assure compliance with payer and regulatory requirements including but not limited to those of Medicare, Medicaid and the State of New Jersey.

This is a Hybrid Position

Education, Knowledge, Skills and Abilities Required:

• BA/BS.
• Minimum of 5 years coding and/or audit experience in a hospital, consulting firm or practice management setting.
• Proficiency with ICD-10 and CPT-4 methodologies.
• Proficiency with physician documentation and reimbursement methodologies.
• Proficiency in the use of an electronic health record, preferably Epic Ambulatory.
• General computer proficiency and organization skills required.

Education, Knowledge, Skills and Abilities Preferred:

• Familiarity with TJC, NJ State DHSS and CMS regulations required with corporate compliance implementation.

Licenses and Certifications Required:

• CCS or CPC or equivalent coding credential.