Billing Compliance Specialist - Behavioral Health

SHIFT:

Day (United States of America)

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A Brief Overview
Under the direction of the Senior Administrative Director, Clinical Managers and Billing Compliance Committee, the Behavioral Health billing compliance specialist will be responsible for reviewing and analyzing billing processes, conducting documentation, coding and billing audits, and ensuring compliance with applicable healthcare regulations for the Department of Child & Adolescent Psychiatry and Behavioral Sciences at The Children's Hospital of Philadelphia.

What you will do

• Systematically monitor, review and analyze patient medical records to determine all appropriate diagnosis and procedures performed. Provide feedback and education to providers.
• Shadow providers at each location within the department and provide on-site education with regards to proper documentation and coding.
• Conduct chart audits for the Department to ensure providers are in compliance with coding and regulatory guidelines.
• Conduct on-site training at each location and provide feedback to providers, managers and director.
• Maintaining thorough knowledge of coding and documentation requirements outlined by CPT, ICD-10-CM and CHOP Compliance for all physician services performed.
• Develop and provide coding and documentation seminars for the providers in the Department and/or present at Departmental meetings.
• Inform providers/directors each year of coding changes for the following year.
• Work with Epic support to ensure that new codes are entered into the system in a timely manner.
• Work with Clinical Providers, Managers and Administrative Director to have a working knowledge of BH Commercial and Medicaid contracts and ensure compliance with quality programs.
• Assist in cost/revenue analysis of any new procedures that providers may want to do.
• Review denials report from the Physician Billing group for trends: e.g., Summarize trends from denials report for each service area and provide feedback and recommendations for reducing denials.
• Meet with Clinical Managers, DCAPBS Administrative Managers and Director and Physician billing department monthly.
• Participate in committees as required.
• Develop CPT “Tip Sheets”, disseminate to Clinicians, post on @CHOP and website for all to access, follow up as necessary.
• Meet with members of CHOP’s Coding and Compliance Department to ensure department policies are line with the hospital.
• Provide coding training to new Clinicians hired within the department 30-60 days after their hire date.

Education Qualifications

• High School Diploma / GED - Required
• Bachelor's Degree - Preferred

Experience Qualifications

• At least five (5) years related experience - Required
• Previous experience with teaching Clinicians guidelines that are compliant with the BH (behavioral Health) regulations set by national standards -Preferred
• Billing experience that involved mental health billing and/or nursing - Preferred

Skills and Abilities

• Knowledge of Microsoft Office Suite including Word, PowerPoint, Excel; internet research skills.
• Excellent communication, interpersonal skills and presentation required.
• Must be able to communicate with clinical staff, administrators and office staff.
• Excellent organizational skills.
• Analytical abilities.
• Excellent written and oral presentation skills.
• Eagerness to learn new areas and work with little supervision.
• Good judgment.
• Ability to work with confidential materials and to manage multiple tasks.
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