The Director of Compliance, Private Practices will oversee and monitor compliance for multispecialty physician practices. This includes the development and implementation of Part B compliance auditing and monitoring, physician education on proper billing requirements, the enforcement and oversight of HIPAA privacy requirements, including relative investigations, corrective action plans and follow up to ensure regulatory requirements are met.
· Conducts regular audits and coordinates ongoing monitoring of Part B physician coding accuracy and documentation adequacy.
· Provides feedback and focused educational programs on the results of auditing and monitoring activities to affected staff and physicians.
· Conducts trend analyses to identify patterns and variations in coding practices.
· Reviews claim denials and rejections pertaining to coding and medical necessity issues and, when necessary, implements corrective action plans, such as educational programs, to prevent similar denials and rejections from recurring.
· Conducts internal investigations of changes in coding practices or reports of other potential problems pertaining to coding.
· Initiates corrective action to ensure resolution of problem areas identified during an internal investigation or auditing/monitoring activity.
· Reports noncompliance issues detected through auditing and monitoring, nature of corrective action plans implemented in response to identified problems, and results of follow-up audits to the VP & Chief Compliance Officer.
· Recommends disciplinary action for violation of the compliance program, the organization's standards of conduct, or coding policies and procedures to the corporate compliance officer.
· Ensures the appropriate dissemination and communication of all regulation, policy and guideline changes to affected personnel.
· Serves as a resource for department managers, staff, physicians, and administration to obtain information or clarification on accurate and ethical coding and documentation standards, guidelines, and regulatory requirements.