Full Job Description Overview:

Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It's also about how we support one another and how we show up for our community. Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change. The Physician Practice Compliance Specialist is responsible for assuring on-going compliance by actively participating in the Compliance Program for Hackensack Meridian Health and for affiliated services. The Physician Prac Compliance Spec assures the integrity of the physician practice regulatory environment in consultation with the Director of Corporate Compliance. This position proactively assesses changes in the regulatory environment; researches, investigates and responds to issues related to documentation, coding and any required licensure. Ensures the accurate documentation of professional services provided throughout the physician enterprise. This position reviews claims, assesses adequacy and recommends enhancements to policies, procedures and internal controls for documentation and billing in order to assure compliance with payer and regulatory requirements including but not limited to those of Medicare, Medicaid and the State of New Jersey. •This is a Hybrid Position•

Responsibilities:

A day in the life of a Physician Practice Compliance Specialist at Hackensack Meridian Health includes: Performs retrospective and concurrent audits and performance improvement reviews to ensure compliance with regulatory and payer requirements. Reviews physician documentation in the medical record for appropriateness and to assure that the bill is reflective of the services provided. Reviews records to assess appropriate ICD-10 and CPT-4 assignment for Medicare, Medicaid and commercial payers for the purpose of reimbursement. Is an active participant in the development of workflow in the practice and in the Electronic Health Record in order to insure compliant documentation and billing. Has regular interaction with practice leadership, physicians, advanced practice nurses, coders, the Physician Billing Department, clerical and practice staff to ensure accurate documentation of services provided. Maintains current knowledge of payer and regulatory requirements, including competency with ICD-10 and CPT-4 coding and for payer billing rules. Develops content and conducts training for physicians and staff to include issues identified through audits, payer activities, performance improvement reviews and changes in regulatory or payer requirements. Recommends updates to compliance manual and policies for the physician enterprise. Monitors all aspects of the revenue cycle in order to assure compliant reimbursement to the group, provides reports as needed. Participates in committee assignments and reports to senior leadership including the Audit and Compliance Committee as needed.

Qualifications:

Education, Knowledge, Skills and Abilities Required:

BA/BS. Minimum of 5 years coding and/or audit experience in a hospital, consulting firm or practice management setting. Proficiency with ICD-10 and CPT-4 methodologies. Proficiency with physician documentation and reimbursement methodologies. Proficiency in the use of an electronic health record, preferably Epic Ambulatory. General computer proficiency and organization skills required.

Education, Knowledge, Skills and Abilities Preferred:

Familiarity with TJC, NJ State DHSS and CMS regulations required with corporate compliance implementation.

Licenses and Certifications Required:

CCS or CPC or equivalent coding credential. If you feel that the above description speaks directly to your strengths and capabilities, then please apply today!

Starting Minimum Rate:

Minimum rate of $97,011.20

Annually Job Posting Disclosure:

HMH is committed to pay equity and transparency for our team members. The posted rate of pay in this job posting is a reasonable good faith estimate of the minimum base pay for this role at the time of posting in accordance with the New Jersey Pay Transparency Act and does not reflect the full value of our market-competitive total rewards package. The starting rate of pay is provided for informational purposes only and is not a guarantee of a specific offer. Posted hourly rates may be stated as an annual salary in the offer and posted annual salaries may be stated as an hourly rate in the offer, depending on the level and nature of the job duties and credentials of the candidate. The base compensation determined at the time of the offer may be different than the posted rate of pay based on a number of non-discriminatory factors, including but not limited to:

Labor Market Data:

Compensation is benchmarked against market data to ensure competitiveness.

Experience:

Years of relevant work experience.

Education and Certifications:

Level of education attained, including specialized certifications, credentials, completed apprenticeship programs or advanced training.

Skills:

Demonstrated proficiency in relevant skills and competencies.

Geographic Location:

Cost of living and market rates for the specific location.

Internal Equity:

Compensation is determined in a manner consistent with compensation ranges for similar roles within the organization.

Budget and Grant Funding:

Departmental budgets and any grant funding associated with the job position may impact the pay that can be offered. Some jobs may also be eligible for performance-based incentives, bonuses, or commissions not reflected in the starting rate. Certain positions may also be eligible for shift differentials for work performed on evening, night, or weekend shifts. 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