Implement and maintain Compliance programs in accordance with the Office of Inspector General's work plan.
Educate providers regarding compliance with government regulations.
Assist in performing analysis of current situations and recommend priorities and goals for future clinic needs.
Identify coding and billings risk areas, conduct focused reviews, and implement corrective action as needed.
Conduct routine internal audits of provider documentation on a timely basis.
Collaborate with physicians and internal staff in development of improved capabilities in the areas of documentation, coding, and compliance.
Review internal controls, policies, and procedures to ensure compliance with appropriate guidelines.
Communicate with Medicare/Medicaid Carriers and third party payers regarding policies and procedures.
Promote Compliance initiatives with clinical faculty and administration.

Work requires organization, analytical and communication skills generally acquired through the completion of a Bachelor's degree program.
Four years of administrative experience to acquire competence in applying compliance, coding and auditing principles as they relate to insurance billing, collections, consulting, and other revenue cycle related functions.
For technical coding, two of the four years of experience with DRG's and APR-DRG's is required.
Experience in formal teaching of coding is preferred.
RHIA or RHIT or CCS required.
For professional coding, specialty coding experience in surgical or E/M coding preferred.
CPC or CCS or RHIT or RHIA or CPMA is required.

Duke Health is committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation or military status.
Essential Physical Job Functions: Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.

Compliance Specialist – Inpatient

Key skills