Compliance Specialist

🔥 0 minutes ago

🏈 Alabama, Arizona, +21 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🦌 Connecticut – Remote 🏛️ District of Columbia – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🗻 New Hampshire – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌲 Oregon – Remote 🚗 Michigan – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote ☕ Washington – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🚔 Compliance

👻 Ghost score 12%

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Duke University Health System

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

📚 Education

💰 $129.6k Grant on 2022-12

Healthcare • Education

Duke University Health System is an academic health system (branded Duke Health) that delivers clinical care, patient services, research and education across multiple integrated divisions. Its offerings include clinical laboratories, primary care, homecare & hospice, patient revenue management, health technology solutions, and transport services such as Duke Life Flight. The organization emphasizes advancing health through patient care, workforce development, and innovation—summarized by its mission “Advancing Health Together”—and is recognized for safety, quality, and employer culture.

📋 Description

• Implement and maintain compliance programs in accordance with the Office of Inspector General's work plan • Educate providers on government regulations, CMS guidelines for academic medical centers, HIPAA, and fraud and abuse • Analyze current situations and recommend priorities and goals for future clinic needs • Identify coding and billing risk areas, conduct focused reviews, and implement corrective actions • Conduct timely routine internal audits of provider documentation • Collaborate with physicians and internal staff to improve documentation, coding, and compliance capabilities • Review internal controls, policies, and procedures for compliance with university, state, and federal guidelines, sound business and finance practices, and clinical goals • Respond to external and internal concerns and implement corrective actions • Communicate with Medicare/Medicaid carriers and third-party payers regarding policies and procedures • Promote compliance initiatives with clinical faculty and administration • Reduce institutional and individual provider legal and financial risk through education and internal audits • Perform other related duties incidental to the work described

🎯 Requirements

• Bachelor's degree • Four years of administrative experience applying compliance, coding, and auditing principles related to insurance billing, collections, consulting, and other revenue cycle-related functions • For technical coding, two of the four years of experience with DRGs and APR-DRGs is required • RHIA, RHIT, or CCS required for technical coding • For professional coding, CPC, CCS, RHIT, RHIA, or CPMA required • Experience in formal or informal teaching of coding preferred • Specialty coding experience in surgical or E/M coding preferred • Knowledge of government regulations, CMS guidelines for academic medical centers, HIPAA, fraud and abuse • Organization, analytical, and communication skills • Ability to conduct coding and billing risk reviews, internal audits, and corrective actions • Ability to review internal controls, policies, and procedures for compliance with university, state, and federal guidelines • Ability to communicate with Medicare/Medicaid carriers and third-party payers

🏖️ Benefits

• $10,000 sign-on bonus paid in 4 equal installments over 24 months at 6-month increments • 100% remote work • Equal employment opportunity • Reasonable accommodation information and provisions