Compliance Specialist, Healthcare

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At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.

About Duke Health's Patient Revenue Management Organization

Pursue your passion for caring with the Patient Revenue Management Organization, which is Duke Health's fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions.

Implement and maintain Compliance programs in accordance with the Office of Inspector General's work plan, to reduce institutional and individual provider legal and financial risk through education and internal audits.

Educate providers regarding compliance with government regulations, with special attention to the Center for Medicare and Medicaid guidelines as they pertain to academic medical centers, HIPAA, and Fraud and Abuse, with periodic updates. Assist in performing analysis of current situations and recommend priorities and goals for future clinic needs. Identify coding and billing risk areas, conduct focused reviews, and implement corrective action as needed.

Conduct routine internal audits of provider documentation on a timely basis. Collaborate with physicians and internal staff in the development of improved capabilities in the areas of documentation, coding, and compliance.

Review internal controls, policies, and procedures to ensure compliance with appropriate University, State, and Federal guidelines and policies, sound business and finance practices, and overall clinical goals and objectives. Respond promptly to external and internal concerns; implement corrective actions as appropriate. Communicate with Medicare/Medicaid Carriers and third party payers regarding policies and procedures. Promote Compliance initiatives with clinical faculty and administration.

Perform other related duties incidental to the work described herein.

Educate providers in regarding compliance with government regulations with special attention to Center for Medicare and Medicaid guidelines as they pertain to academic medical centers, HIPAA, and Fraud and Abuse with periodic updates. Assist in performing analysis of current situations and recommend priorities and goals for future clinic needs. Identify coding and billings risk areas, conduct focused reviews, and implement corrective action as needed.

Conduct routine internal audits of provider documentation on a timely basis.

Collaborate with physicians and internal staff in development of improved capabilities in the areas of documentation, coding, and compliance. Review internal controls, policies, and procedures to ensure compliance with appropriate University, State, and Federal guidelines and policies, sound business and finance practices, and overall clinical goals and objectives. Respond promptly to external and internal concerns; implementing corrective actions as appropriate. Communicate with Medicare/Medicaid Carriers and third party payers regarding policies and procedures.

Promote Compliance initiatives with clinical faculty and administration. Perform other related duties incidental to the work described herein.

Educate providers in regarding compliance with government regulations with special attention to Center for Medicare and Medicaid guidelines as they pertain to academic medical centers, HIPAA, and Fraud and Abuse with periodic updates. Assist in performing analysis of current situations and recommend priorities and goals for future clinic needs. Identify coding and billings risk areas, conduct focused reviews, and implement corrective action as needed.

Conduct routine internal audits of provider documentation on a timely basis. Collaborate with physicians and internal staff in development of improved capabilities in the areas of documentation, coding,and compliance. Review internal controls, policies, and procedures to ensure compliance with appropriate University, State, and Federal guidelines and policies, sound business and finance practices, and overall clinical goals and objectives. Respond promptly to external and internal concerns;

implementing corrective actions as appropriate. Communicate with Medicare/Medicaid Carriers and third party payers regarding policies and procedures. Promote Compliance initiatives with clinical faculty and administration. Perform other related duties incidental to the work described herein.

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