"DCG Billing Compliance Analyst"

Job Summary

The DCG Billing Compliance Analyst will conduct internal billing and documentation audits and compliance investigations; produce audit reports and findings with viable recommendations, monitor internal compliance reports.

Responsibilities

The duties include, but are not limited to:

• AUDITING & MONITORING: Performance of interim, and annual billing, documentation audits across multiple dental and medical specialties and programs for faculty, resident and student providers to identify potential compliance risks and assist with the development of corrective action plans.
• Monitor and analyze missing charge and procedure reports, communicate and coordinate with Program Directors on chart deficiencies, verify chart updates. Monitor and analyze corrective action plans to ensure DCG billing operations are aligned with DCG and Augusta University policies and adhere to contractual (commercial insurance), federal, state, local, regulatory documentation, coding and billing requirements.
• EDUCATION & TRAINING: Provide periodic training to providers and employees on DCG and Augusta University compliance policies to include but not limited to contractual (commercial insurance); regulatory (e.g. False Claims Act, Stark Laws, Anti-Kickback Statutes) for billing, coding, and documentation referrals, and contracts.
• REPORTING: Prepare and submit annual and interim audit reports. Maintain detailed records of audit and monitoring activities for reporting to the Director of Regulatory Compliance. Analyze audit data to identify trends to aid in developing recommendations for training or corrective action plans
• INVESTIGATIONS: Conduct investigations of potential compliance violations using the University System of Georgia (USG) investigation guidance. Perform root cause analyses. Prepare reports in accordance with USG and AU protocols and standards.
• PROFESSIONAL DEVELOPMENT: Maintain current and applicable knowledge of payor billing rules, federal and state documentation and billing laws and industry standards, CDT, CPT, ICD-10-CM, and HCPCS coding guidance through attendance of conferences, webinars, and other professional development activities
• OTHER DUTIES: Perform all other job-related duties as assigned.

Required Qualifications

Bachelor's degree from an accredited college or university in healthcare or business-related field with two years of clinical or administrative experience in dental or medical healthcare environment as a certified coder with certification form the American Academy of Professional Coders (AAPC), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Dental Assisting National Board (DANB) or American Health Information Management Association (AHIMA). Third-party and federal payor insurance background/experience and knowledge of coding, billing, documentation, and reimbursement criteria. OR Associate's degree from an accredited college or university in healthcare or business-related field with four years of clinical or administrative experience in dental or medical healthcare environment as a certified coder with certification form the American Academy of Professional Coders (AAPC), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Dental Assisting National Board (DANB) or American Health Information Management Association (AHIMA). Third-party and federal payor insurance background/experience and knowledge of coding, billing, documentation, and reimbursement criteria.

Preferred Qualifications

Master's degree from an accredited college or university in healthcare or business-related field. Advanced knowledge of the Center for Medicare and Medicaid Services and other third-party payor coding, billing, and documentation criteria. Four or more years of clinical or administrative experience in dental or medical healthcare auditing billing, coding, and documentation for professional claims across multiple specialties. Five or more years of experience in compliance auditing and monitoring roles. Certified in Healthcare Compliance (CHC) Knowledge of audit sampling methodologies.

Knowledge, Skills, & Abilities

• KNOWLEDGE: Knowledge of healthcare compliance concepts and applicability to audits and risk assessments. Knowledge of Center for Medicare and Medicaid Services (CMS) reimbursement principles.
• SKILLS: Strong project management skills, along with the ability to take initiative and work independently.
• ABILITIES: Ability to maintain confidentiality. Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to effectively present information. Ability to apply a systematic approach to problem-solving and troubleshooting.

Certifications/License

Certified coder with certification form the American Academy of Professional Coders (AAPC), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Dental Assisting National Board (DANB) or American Health Information Management Association (AHIMA).