Compliance/Quality Specialist & Medical Coder

Responsibilities

The Compliance/Quality Specialist & Medical Coder is responsible for ensuring that the organization adheres to legal, regulatory, and accreditation standards. This role involves monitoring and reporting on the effectiveness of compliance controls, providing guidance on compliance matters, and assisting in the implementation of compliance programs. The CQS works closely with clinical staff, administration and other departments to ensure compliance and mitigate risks associated with healthcare. The CQS is responsible for reviewing and accurately coding medical records and documents in accordance with industry standards and regulatory requirements. This role involves converting healthcare diagnoses, procedures, medical services, and equipment into universal medical alphanumeric codes. The medical coder ensures correct application of coding guidelines to maximize reimbursement and support healthcare operations. In addition, you will:

• Monitor and interpret regulations and updates from bodies such as HIPAA, OSHA, Joint Commission and other relevant federal, state and local regulations.
• Support organization compliance with all relevant laws and regulations.
• Develop, implement, and maintain compliance policies and procedures ensuring accuracy and reflection of regulatory requirements and best practices.
• Support strategies that identify, assess and mitigate compliance risks to the organization.
• Conduct regular internal compliance & quality audits/assessments and support Director of Compliance/QI for external audits conducted by DIA, DHS, The Joint Commission, HCBS, CMS
• Member of various Compliance, Quality and Clinical committees with reporting on the effectiveness of the compliance and quality programs.
• Support the investigation of compliance violations and privacy breaches.
• Collaborate with clinical staff, administration, and other departments on the development of plans of corrective action including implementation follow up and re-assessment.
• Provide guidance and support on compliance and quality matters to all levels of employees.
• Ensures the quality of the medical record by verifying completeness and accuracy and ensures proper entry into the electronic health record system (EHR).
• Obtains additional information from physicians or other medical providers when conflicting or ambiguous clinical documentation is encountered.
• Utilize ICD -10 to code diagnoses and assign and sequence all diagnosis codes for services.
• Research and communicate coding and regulation changes for reimbursement. Provides ongoing feedback to physicians and other providers regarding coding guidelines and requirements.
• Assist with educational needs for physicians, other providers, and clinical staff relating to documentation compliance, as well as new policies and procedures related to billing, as required.
• Assists in updating CPT/HCPCS/ICD-10/DSM-V codes in the electronic health records (EHR) as assigned.
• Acts as a resource on payer reimbursement rates, utilizing current fee schedules.
• Resolves coding issues in the electronic health record (EHR). Perform research on coding issues, as requested.
• Other duties as assigned.

Requirements

Education:

• High school diploma or equivalency required.
• Associate’s degree in health information technology, medical coding, healthcare administration or related field required.
• Bachelor’s degree in healthcare administration, psychology, social work or related field preferred.

Experience:

• Minimum of 3 – 5 years’ experience in a compliance and/or quality role, preferably in a mental health or healthcare setting.

  
  

• Working knowledge of legal and quality management principles, health statistics, release of information, data analysis and confidentiality/privacy rules & regulations.

  
  

• Previous experience working with insurance companies, billing, etc. in a health care setting.

  
  

• Knowledge of coding systems including ICD-10, DSM 5, CPT, and HCPCS.

• Working knowledge of anatomy and physiology, disease processes, informatics, business and computer technology, and practical applications in coding, and reimbursement, as well as the ability to utilize software applications that collect, store, process, retrieve and analyze health information.

Knowledge/Skills:

• Strong knowledge of mental health regulations and compliance standards.

• Ability to communicate clearly, tactfully, and professionally with peers, clinical staff, administration and clients/patients.

• Have flexibility to change, prioritize tasks and work under pressure to meet deadlines.

• Strong attention to detail and can plan and organize work.

• Excellent analytical and problem-solving skills.

• Excellent written and verbal communication skills.

• Ability to work independently and as part of a team.

• Proficient with computer applications (e.g. Microsoft, EHR)

Licenses/Certifications:

• Mandatory Reporter of Child/Dependent Adult Abuse Certification or the ability to obtain within six (6) months of hire and every three (3) years thereafter required.
• Medical coding, compliance or quality certification or preferred.

Benefits

Competitive benefits package for full-time employees working 30+ hours a week:

• Health insurance (up to 79% employer paid)
• Dental insurance
• Vision insurance
• 401(k) with profit sharing and employer match
• Paid time off (accrue up to 80 hours during first year of employment; increases based on tenure with agency)
• 10 paid holidays
• 80 hours sick time
• 2 wellness days
• Staff development and training
• Public Service Loan Forgiveness (PSLF) eligibility for federal student loans
• Employer paid CEU's through Relias
• PerkSpot- employee discount program
• Employee assistance program
• Advancement opportunities

About the Organization

Hillcrest is a non-profit organization that assists adults and children in need of help. Every day, Hillcrest builds confidence in hundreds of people and families. We strive to be a leading provider in supporting brain health and wellness. We’re a place where compassion is commonplace. Where our passion soars and faith restores.

**COVID-19 Vaccination Not Required*