RHIA Compliance Associate, II

At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As an integral part of our team, you'll have the opportunity to join our quest for better health care, no matter where you work within the Northwestern Medicine system. We pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, our goal is to take care of our employees.

Ready to join our quest for better?

• This position has primary responsibility for auditing/reviewing provider documentation, coding, and billing to ensure that the documentation supports the CPT codes billed to government payors.
• Results of the provider audits/reviews are shared with the provider, so strong written and verbal communication skills are important.
• Strong coding understanding, professional coding certification is required. Professional coding experience is preferred.
• Responsible for answering inquiries related to professional documentation, coding, and billing regulatory requirements. Work with Senior/Manager/Director on more complex issues or investigations.
• Help manage all aspects of the Compliance Hotline and compliance issues received via e‑mail and phone.
• Help ensure reported issues are appropriately received, evaluated, investigated, documented, and resolved.
• Respond to queries or allegations and triage issues to appropriate departments when necessary (i.e., Human Resources Compliance).
• Assist with maintaining a log/database of all issues received by the department through the compliance hotline, e‑mails, phone calls, etc.
• Document all issues received, actions taken, and resolutions.
• Maintain a current understanding of regulatory trends and changes in compliance and regulatory guidelines that affect NMHC and its subsidiaries by monitoring various resources to assess regulatory changes and determine organizational impact.
• Coordinate investigations in response to incoming compliance related issues.
• Gather all relevant information for potential compliance issues, determine underlying causes, and relate information from different sources to draw logical conclusions.
• Coordinate non‑coding and non‑billing related audits, reviews and, when necessary, investigations (in conjunction with the Corporate Compliance Manager) in response to CMS, OIG, and/or other regulatory concerns that emerge throughout the year.
• Perform follow‑up, audits, reviews, investigations, and validations.
• Assist with data analysis to determine root cause of reported or identified issues and determine level of escalation required.
• Assist with the development of compliance education and training materials.
• Assist departments in the development of corrective action plans for identified issues.
• Assist with the development of dashboards, written reports, or other deliverables to be presented to the department, VP Integrity, Senior Leadership, and/or the Audit Committee.
• Support and assist the Corporate Compliance Manager in identifying and assessing areas of compliance risk for NMHC.
• Assist with the development and implementation of the department's annual Compliance Work Plan.
• Help develop and maintain compliance‑related policies and procedures to ensure they are current and relevant.
• Assist with providing policy‑related guidance to individuals and departments.
• Perform other duties assigned by the department Managers, Director, or VP, Integrity.

AA/EOE.

• Bachelor's Degree.
• RHIA, CPC or similar credential.
• Demonstrated ability to work with various levels within the organization regarding confidential information and maintain sensitive data.
• Strong interpersonal and communications skills required.
• Ability to work collaboratively and communicate with others in a clear, concise, and professional manner on the telephone and in person, as well as demonstrate use of good written and verbal communication skills.
• Knowledge and experience in using Word, Excel, PowerPoint, Access and similar Office programs.

• Certified Healthcare Compliance (CHC)…