Compliance Resource Specialist (CPT Certification Required) - Surgery

$59,895 - $89,843/Yr

Mount Sinai Health System - New York, NY

Full-time - Mid Level

New York, NY

10,001+ employees

Hospitals

About the position

The Compliance Resource Specialist (CRS) plays a crucial role in ensuring compliance with federal and state regulations regarding clinical documentation and billing practices. This position involves monitoring clinical documentation, providing education and training, and collaborating with various stakeholders to maintain compliance standards in billing and reimbursement processes.

Responsibilities

• Perform monitoring activities on assigned areas based on risk profiles.
• Notify the Departmental Chair/Divisional Chief and Administrator of scheduled monitoring initiatives.
• Meet with the Administrator or appropriate staff to discuss billing processes unique to service specialties.
• Analyze Utilization Billing Reports and determine sample selection for review.
• Perform chart abstraction either retrospectively or concurrently.
• Enter information in the compliance database to generate reports.
• Perform quality checks to ensure data accuracy.
• Prepare departmental summary reports of monitoring findings for review by the Director of Hospital Compliance or Chief Compliance Officer.
• Present reports to Department Chair/Divisional Chief and other staff as appropriate.
• Prepare individual analysis reports for all monitored physicians.
• Meet with individual physicians to discuss analysis reports and findings.
• Collaborate with Administrator regarding refund processes to third-party payers as appropriate.
• Maintain files of all monitoring data for each assigned physician/practice/department.
• Provide clinical documentation and billing compliance education supporting federal and state regulations.
• Provide group or individual training based on documentation reviews.
• Provide periodic updates for providers regarding changes in regulations and reimbursement policies.
• Provide ongoing training regarding billing compliance as it relates to clinical documentation elements.
• Review requirements and supporting documentation needed for compliance with audits and monitoring activities.
• Perform literature searches to respond to inquiries related to billing and regulatory rules.
• Assist in the development of documentation templates for compliance.

Requirements

• Minimum of 4 years of experience in billing compliance.
• Knowledge of CPT and ICD 9 codes and current Medicare and Medicaid rules regarding clinical documentation and billing compliance for Part A and Part B services.
• Current CPT Certification for Hospital and Part B is required, as well as a CPC certification.
• Strong communication and interpersonal skills to work effectively with diverse individuals and groups.
• Ability to prepare written reports in a timely manner.
• Proficiency in basic data entry and retrieval systems.
• Ability to follow up on issues and communicate with appropriate personnel.
• Willingness to seek opportunities for professional growth in billing compliance.

Benefits

• Competitive salary range of $59,895 - $89,843 annually based on experience and education.
• Opportunities for professional development and training.