Compliance Audit & Education Specialist - Compliance & Integrity

The Compliance Audit & Education Specialist carries out the annual medical billing and coding compliance audit plan and ensures compliance with current government and industry audit practices and requirements.

Schedule: Full-time, Benefits Eligible

Location: Near East Office Building431 S. 18th StreetColumbus, Ohio 43205United States

Work environment: Hybrid - 2 days in office, 3 days remote

Why Nationwide Children's Hospital?

The moment you walk through our doors, you feel it. When you meet our patient families, you believe it. And when you talk with anyone who works here, you want to be part of it. Welcome to Nationwide Children’s Hospital, Where Passion Meets Purpose.

Here, Diversity, Equity and Inclusion are integrated into our core values and practices. We are passionate about building, sustaining and evolving an inclusive and equitable environment. We are seeking individuals who live these values and want to share their experiences and efforts in support of our collective mission.

We’re 14,000 strong. And it takes every one of us to improve the lives of the kids we care for, and the kids around the world we’ll never meet. Kids who live healthier, fuller lives because of the knowledge we share. We know it takes a Collaborative Culture to deliver on our promise to provide the very best, innovative care and to foster new discoveries, made possible by the most groundbreaking research. Anywhere.

Ask anyone with a Nationwide Children’s badge what they do for a living. They’ll tell you it’s More Than a Job. It’s a calling. It’s a chance to use and grow your talent to make an impact that truly matters. Because here, we exist simply to help children everywhere.

Nationwide Children’s Hospital. A Place to Be Proud.

Responsibilities

Conduct billing and coding compliance audits, which includes a review of inpatient and outpatient medical records to determine appropriateness of documentation, procedure, and diagnosis coding.

Audits involve professional and facility billing.

Conducts analysis and be able to apply state and federal healthcare or related regulations to different questions, projects or inquiries presented to the Compliance Department.

Investigates, responds, and communicates information regarding coding, documentation, compliance, and reimbursement questions.

Analyzes coding issues and questions from both a compliance and reimbursement perspective.

Provides compliance and documentation education sessions to practitioners and other staff.

Assists in creating standardized, organization-wide educational resources regarding coding and documentation best practices.

Delivers new provider onboarding regarding revenue cycle compliance.

Qualifications

Education:

Associates Degree in Health Information Management or other healthcare related field.

Bachelors degree preferred or equivalent combination of work and educational experience.

Required Certifications:

Certified Professional Coder (CPC), CCS-P or other similar coding certification required.

Skills:

Proficient in Microsoft Office Suite.

Excellent written, verbal, and interpersonal communication skills to interact with all levels of hospital staff and external agencies and individuals.

Ability to work independently with minimal supervision required.

Ability to work with highly confidential materials.

Must possess high ethical standards.

Provider education and compliance.

Experience:

2-3 years of professional coding experience, preferably in a pediatric healthcare setting.

Auditing experience and hospital coding experience preferred.

Teaching or public speaking experience desired.

Working knowledge of Medicaid coding regulations.

The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individual so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under his/her supervision.

EOE M/F/Disability/Vet

Full Time