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Employment Type:

Full time

Shift:

Description:

Responsible for the data capture, analysis & reporting information to assist the Trinity Health leadership team achieve operational efficiency while ensuring compliance with healthcare, coding, and billing regulations.

Responsible for objectively auditing and monitoring enterprise information, with particular attention to coding and billing regulations; producing reports & suggesting improvements to processes. Assists management in training and onboarding new colleagues. Provides knowledge & expertise in the program, services & applications.

Trinity Health

Senior Coding Compliance Specialist

Assists management in conducting annual, periodic and project level risk assessments in support of the Trinity Health Integrity & Compliance Program (ICP).

Performs risk assessments that consider legal and regulatory compliance risks applicable to Trinity Health operations as identified by Department of Health & Human Services (DHHS) – Office of Inspector General (OIG), Centers for Medicare & Medicaid Services (CMS), Department of Justice (DOJ) as well as input received from internal Trinity Health stakeholders.

Assists management in resolution of hotline incidents involving coding or billing activities, providing subject matter expertise. Provides education to colleagues and industry stakeholders on relevant coding and compliance topics.

Assists in the development of risk mitigation strategies, monitoring programs, and annual work plan production. Proactively monitors changes in laws, regulations and business ethics practices impacting corporate compliance programs.

Assists management in ensuring the ICP fully meets all requirements for effective corporate compliance programs as established by health care industry regulators.

Bachelor’s degree in a healthcare related field, or equivalent combination of education & clinical reviews/coding/billing experience.

Minimum of six years of experience within a health care organization or equivalent work experience involving regulatory, clinical documentation & coding reviews. Must possess working knowledge of Medicare & third-party payer regulations. Previous experience in health care compliance programs or equivalent work experience demonstrating knowledge & understanding of the laws & regulations impacting the health care provider industry, specifically health care corporate compliance programs & relevant knowledge in areas of revenue cycle, coding & billing, physician financial relationships, payer contracting, conflicts of interest and/or clinical research. Must possess detailed knowledge of federal, state & local laws & regulations impacting health care corporate compliance programsExperience with government audits, inquiries, investigations, response, & mitigation.

Must possess in-depth knowledge of CPT, HCPCS, ICD-10-CM & ICD-10-PCS coding & billing regulations required. AHIMA, AAPC, or equivalent certification required, e.g., Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Registered Health Information Technologist (RHIT), or Registered Health Information Administrator (RHIA).

Must possess a thorough understanding & knowledge of health care legal & regulatory practices, financial & internal control systems/procedures. Must understand and have in depth knowledge of Hospital Outpatient Prospective Payment System, Inpatient Prospective Payment System, Medicare Physician Fee Schedule, Inpatient Psychiatric Prospective Payment System, Inpatient Rehabilitation Facility Prospective Payment System, Ambulatory Surgery Center Payment System, Provider-Based requirements, EMTALA, Price Transparency & No Surprises Act regulations. Must have extensive knowledge in the guidance outlined in the Medicare Claims Processing Manual, Medicare Program Integrity Manual, & National Correct Coding Initiative (NCCI) Policy Manual.

Hourly pay ranges: $35.63 - $53.45

Additional Qualifications (nice to have)

Possess & maintain licensure or certification in compliance, law, audit, privacy, healthcare, or other relevant field or area of study.

Master's or professional degree in law, business or health care.

. Experience supporting compliance program operations such as policy management, training & education programs, & investigations preferred.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran