RHIA Compliance Associate, II

Northwestern Medicine; Chicago (IL); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Tuition reimbursement

Loan forgiveness

401(k) matching

Lifecycle benefits

Job summary

A healthcare provider in Chicago is seeking a Compliance Auditor to perform audits on provider documentation and coding. Responsibilities include managing compliance issues and communicating effectively with providers regarding results. Candidates should have a Bachelor's Degree and relevant certifications like RHIA or CPC. Strong interpersonal skills and experience in healthcare compliance are preferred. This role offers competitive benefits and opportunities for professional growth.

Qualifications

• Bachelor's Degree is mandatory, with a preference for RHIA, CPC or similar credential.
• Strong interpersonal skills required to interact with various organizational levels.
• Confidentiality and the ability to maintain sensitive data are critical.

Responsibilities

• Auditing provider documentation, coding, and billing accuracy.
• Communicating audit results to providers effectively.
• Managing compliance issues through hotline and documentation logging.

Skills

Strong interpersonal and communication skills

Ability to work collaboratively

Demonstrated ability to handle confidential information

Strong written and verbal communication skills

Data analysis skills

Education

Bachelor’s Degree

RHIA, CPC or similar credential

Tools

Word

Excel

PowerPoint

Access

Job description

At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As an integral part of our team, you'll have the opportunity to join our quest for better health care, no matter where you work within the Northwestern Medicine system. We pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, our goal is to take care of our employees. Ready to join our quest for better?

Responsibilities

• Primary responsibility for auditing/reviewing provider documentation, coding, and billing to ensure the documentation supports the CPT codes billed to government payors.
• Share audit/review results with the provider; strong written and verbal communication skills are essential.
• Strong coding understanding required; professional coding certification is required, and professional coding experience is preferred.
• Answer inquiries related to professional documentation, coding, and billing regulatory requirements; work with senior/manager/director on complex issues or investigations.
• Help manage all aspects of the Compliance Hotline and compliance issues received via e-mail and phone.
• Ensure reported issues are appropriately received, evaluated, investigated, documented, and.
• Assist with maintaining a log/database of all issues received by the department through the compliance hotline, e-mails, phone calls, etc.
• Document all issues received, actions taken, and resolutions.
• Maintain a current understanding of regulatory trends and changes in compliance and regulatory guidelines that affect NMHC and its by monitoring various resources and assessing organizational impact.
• Coordinate investigations in response to incoming compliance related issues.
• Gather all relevant information for potential compliance issues, determine underlying causes, and relate information from different sources to draw logical conclusions.
• Coordinate non-coding and non-billing related audits, reviews and, when necessary, investigations in conjunction with the Corporate Compliance Manager in response to CMS, OIG, and other regulatory concerns.
• Perform follow‑up, audits, reviews, investigations, and validations.
• Assist with data analysis to determine root cause of reported or identified issues and determine level of escalation required.
• Assist with the development of compliance education and training materials.
• Assist departments in developing corrective action plans for identified issues.
• Assist with the development and implementation of dashboards, written reports, or other deliverables to be presented to the department, VP Integrity, Senior Leadership, and/or the Audit Committee.
• Support and assist the Corporate Compliance Manager in identifying and assessing areas of compliance risk for NMHC.
• Assist with the development and implementation of the department’s annual Compliance Work Plan.
• Help develop and maintain compliance‑related policies and procedures to ensure they are current and relevant.
• Assist with providing policy‑related guidance to individuals and departments.
• Perform other duties assigned by the department managers, director, or VP, Integrity.

Qualifications

Required

• Bachelor’s Degree.
• RHIA, CPC or similar credential.
• Demonstrated ability to work with various levels within the organization regarding confidential information and maintain sensitive data.
• Strong interpersonal and communications skills required.
• Ability to work collaboratively and communicate with others in a clear, concise, and professional manner on the telephone and in person, as well as demonstrate use of good written and verbal communication skills.
• Knowledge and experience in using Word, Excel, PowerPoint, Access and similar Office programs.

Preferred

• Certified Healthcare Compliance (CHC) certification.
• JD, MBA or similar degree.
• Healthcare compliance experience.

AA/EOE.

Additional Information

Northwestern Medicine is an equal opportunity employer (disability, VETS) and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.

Background Check

Northwestern Medicine conducts a background check that includes criminal history on newly hired team members and, at times, internal transfers. If you are offered a position with us, you will be required to complete an authorization and disclosure form that gives Northwestern Medicine permission to run the background check. Results are evaluated on a case‑by‑case basis, and we follow all local, state, and federal laws, including the Illinois Health Care Worker Background Check Act.

Benefits

We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well‑being while providing protection for unexpected life events. Please visit our Benefits section to learn more.

Sign‑on Bonus Eligibility

Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign‑on bonus. Exception: New graduate internal employees seeking their first licensed clinical position at NM may be eligible depending upon the job family.