Washington University is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity or expression, national origin, genetic information, disability, or protected veteran status.
This position is full-time and works approximately 40 hours per week.
Department Name/Job Location:
This position is in the Department of Anesthesiology. This position is for the Medical School Campus.
Position is responsible for developing, implementing and monitoring the special investigative function for Billing Compliance within the Department of Anesthesiology. Directs special investigations and/or reviews resulting from internal and/or external inquiry and/or reporting, working closely with the Department compliance officer� and University compliance groups , including formulation and follow through of corrective action. Monitors services provided by outside consulting groups and audit activity of external entities related to documentation and professional fee billing compliance issues.
PRIMARY DUTIES AND RESPONSIBILITIES:
Responsible for monitoring/maintaining internal Department compliance function accessible to all faculty and staff for internal inquiries concerning billing practices and/or reports of non-compliance. Include assignment of case number, logging of complaints and investigation results and measures to allow follow-up while maintaining caller’s anonymity.
Responsible for investigating all inquiries concerning billing practices or reports of non- compliance reported directly to the compliance office or via the help line, or per request of the Department Leadership. Process may include establishing audit methodology, developing appropriate data-collection forms, consulting with general counsel, supervising the audit process, compiling and analyzing data/results and preparation of written reports including recommendation of corrective action. Present findings, as indicated, to key member of the compliance team, including compliance leader, Executive Director, Department Chair and Division Chiefs as appropriate.
Performs Departmental� internal risk assessment to identify possible compliance risk including, but not limited to, historical claims analysis, analysis of physician/division practice patterns as compared to national standards and Medicare utilization tables and assessment of software and electronic modules/programs /systems utilized in the billing process. Analyzes data to determine education and/or special audit needs. Reviews current professional billing operations utilized by each clinical division, including evaluation of software program/programming in use and review of contracted third-party entities to evaluate/facilitate compliance.
Acts as physician/provider advocate and intermediary with University compliance offices, third-party payers, medical professional organizations in relation to compliance-related issues. Monitors federal and other payer publications for current and proposed changes in regulation affecting professional fee billing, taking proactive action as indicated.
Monitor/track audit activity by outside entities and contracted services of third-party entities, including consultative groups, related to professional fee billing and other compliance-related issues.
Oversees Department billing compliance education effort. Participates with Executive Director and Billing Director in strategic planning related to the overall direction of the billing education program, reviews and approves training materials, educational programs and publications related to billing and documentation practices produced by compliance education team.
Works with each Division within the Department to evaluate training opportunities with documentation and billing compliance and helps implement training programs to keep in compliance.�
Must be a graduate of an accredited school of nursing with current RN licensure in the state of Missouri, and/or graduate of a Health Information Management program (RHIA/RHIT) or equivalent education/experience in health related field.
Experience in health law or paralegal studies.
Knowledge of HCFA documentation and billing regulations.
Experience in medical record review for documentation and/or utilization review or continuous quality improvement preferred, diverse clinical background.
Ability to work independently.
Knowledge of ICD-9, CPT coding and PC spreadsheets.
Experience with IDX billing systems.
Interactive communication skills with the ability to speak in front of large and small groups.
Ability to work with physicians one-on-one and in groups.
The hiring range for this position is $78,166 - $99,673 annually.
-Retirement Savings Plan -22 vacation days -8 Paid Holidays -Sick Time -Tuition benefits for employee, spouse and dependent children -Free Metro Link/ Bus pass -Free Life Insurance -Health, Dental, Vision -Health Savings Accounts (HSA) -Long Term Disability Insurance -Flex Spending Plan -Other Benefits
Med School HR website (medschoolhr.wustl.edu)
Internal Applicant Instruction:
This position is grade C16.
Please attach a copy of your most current signed performance evaluation (completed within the last 18 months) to your online account. If you have not received a performance evaluation, you may provide two current signed letters of recommendation (written within the last 18 months), preferably to include one letter from either a current or recent former supervisor. To attach these documents, go to: My Career Tools, Add Attachment, Attachment Type – Performance Reviews or Letters of Recommendation.
Washington University in St. Louis, a medium-sized, independent university, is dedicated to challenging its faculty and students alike to seek new knowledge and greater understanding of an ever-changing, multicultural world. The University offers more than 90 programs and almost 1,500 courses leading to bachelor's, master's and doctoral degrees in a broad spectrum of traditional and interdisciplinary fields, with additional opportunities for minor concentrations and individualized programs. The faculty is composed of scholars, scientists, artists and members of the learned professions. They serve society by teaching; by adding to the store of human art, creativity, understanding, and wisdom; and by providing direct services, such as health care.