Sr. Compliance Coordinator-Billing & Coding

Additional Information About the Role

• Remote opportunity- must reside in the Greater St. Louis Metropolitan area!
• Experience with analyzing provider data and training on current billing guidelines to identify trends is a plus!
• Previous auditing experience of evaluation and management and surgical procedures is preferred!
• Working knowledge of EXCEL and MS Publisher.

BJC Medical Group is the multi‑specialty physician‑led organization of BJC Health Care and includes over 600 doctors and advanced practice providers who are affiliated with top‑ranked hospitals in the Midwest region.

Since 1994, BJC Medical Group has provided access to extraordinary care in over 145 locations and over 25 specialties in the greater St. Louis, mid‑Missouri and southern Illinois areas. Our providers are nationally recognized for excellent patient satisfaction, quality health care, and improving the health and well‑being of the communities we serve.

The Quality and Compliance Department supports the strategic and operational objectives of BJC Medical Group practices and is located in Town & Country, MO.

The Senior Compliance Coordinator conducts and coordinates reviews of BJCMG specialty provider documentation to ensure accuracy of services billed. This position prepares reports of findings to be presented to providers. It also develops educational opportunities for new and existing providers, giving instruction on federal and state regulations, documentation guidelines, and coding training in a way that ensures compliance with governmental regulations.

Additionally, the Senior Compliance Coordinator collaborates with departments to provide appropriate education to staff as it relates to compliance and privacy of protected health information.

• Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services identified as part of the review for specialty providers or upon request from management.
• Interacts with specialty providers regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non‑specific documentation based on the review.
• Develops and/or presents educational training material to specialty providers and coders based on findings and trends identified as a result of the reviews; provides general education on coding and documentation rules and regulations, regulatory provisions, and third‑party payer requirements to new employees and providers, including Employee and Provider New Employee Orientation.
• Interacts with government agencies/contractors, management, employees and others as necessary to ensure an understanding of the organization’s compliance initiatives.
• Conducts and coordinates routinely scheduled reviews of BJCMG specialty providers’ documentation involved with professional fee billing for accuracy of coding and physical presence; reviews consist of ambulatory E&M services and office procedures, as well as hospital admissions, subsequent visits, hospital procedures, and all other services performed by BJCMG specialty providers; reviews medical record documentation to identify under‑coded and over‑coded services, prepares reports of findings, and meets with providers to provide education and training on accurate coding practices and compliance issues;
  
  serves as subject matter expert related to specialty coding.
• Conducts focused reviews across the BJCMG enterprise based upon the Compliance Department’s annual work plan and/or trends identified based upon internal reviews or requests from senior leadership; performs special projects as requested/assigned by management; monitors trends across the organization and develops education and training on accurate coding practices and compliance issues.
• Provides guidance and serves as mentor to fellow coordinators related to the audit process, coding, billing and compliance; identifies and notifies management educational opportunities and/or concerns as a result of serving as lead auditor.
• Supports the HIPAA liaison by tracking and conducting employee investigations when requested.