The Clinical Compliance Specialist will be responsible for conducting patient bill audits to identify any billing irregularities in response to third party payors and patient requests for all of Ballad Health hospitals. The Clinical Compliance Specialist is responsible for coordinating annual audits conducted by third party payors.
- This position will work closely with the Charge Master Team, Patient Financial Services, Coding, Medical Records, and all departments within the organization in an effort to enhance the overall charge control for Ballad Health facilities.
- The Clinical Compliance Specialist will frequently communicate with Management and other personnel at all levels of the organization.
- In addition, the Clinical Compliance Specialist will have contact with external auditors, legal counsel, federal, state, and local agencies, vendors, physicians and their staff, and other parties.
- The Clinical Compliance Specialist will be responsible for assisting in compliance reviews, special assignments, requests from legal or Risk Management, and research and advisory projects in order to further ensure compliance with laws and regulations by Ballad Health and its subsidiaries.
- This position consist of routine and project oriented work.
- This position requires confidence and someone who can work independently, self-motivated, and possesses the ability to conduct independent research.
- Clinical Compliance Specialist must be a proficient communicator, be able to speak in front of people, and able to relate well to all levels of staff.
- Auditing requires concentration, close attention to detail, objectivity, resourcefulness, the ability to maintain confidentiality of sensitive information and the ability to work within specified time constraints.
- Ability to manage multiple tasks and meet deadlines.
- Based on audit results, the Clinical Compliance Specialist will make recommendations and guide department leaders to implement corrective action plans as needed to ensure efficiency, accuracy, and compliance with internal and external policies and standards.
- This position requires a licensed clinician, preferably an RN, with experience in a hospital setting.
- A minimum of three years prior auditing experience is required.A working knowledge of charging processes, coding and reimbursement methodologies is required.
- Experience with business computer applications, including word, excel, and power point is required.
- Professional certification from a credentialing body such as AHIMA, AAPC, HCCA is preferred. [For example, Certification in Healthcare Compliance (CHC), Certified Coding Associate (CCA), Certified Practical Coder (CPC), Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT)].
Instructions for Resume Submission:
Apply online and choose Ballad Health Jobs 1 for job posting.