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Medical Compliance Specialist I - Hospital Billing

Company name
University of Miami

Miami, FL

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The University of Miami is considered among the top tier institutions of higher education in the U.S. for its academic excellence, superior medical care, and cutting-edge research. At the U, we are committed to attracting a talented workforce to support our common purpose of transforming lives through teaching, research, and service. Through our values of Diversity, Integrity, Responsibility, Excellence, Compassion, Creativity and Teamwork (DIRECCT) we strive to create an environment where everyone contributes in making UM a great place to work. We are one of the largest private employers in Miami-Dade County; home to more than 13,400 faculty and staff from all over the world.

Medical Compliance has an opportunity for a Medical Compliance Specialist I. The Medical Compliance Specialist I (Hospital Billing - HB) is part of the Office of Billing Compliance team and promotes health care compliance within UHealth/University of Miami/the Miller School of Medicine. Under the direction of the Manager (HB) the Compliance Specialist is responsible for conducting hospital billing and coding reviews of the UHealth/University of Miami Hospitals and related departments. He/she will contribute to the success of the compliance program by strategizing compliance risk assessment, summarizing and documenting compliance-related documentation and coding reviews with members of the medical community, regulatory entities and any others involved in the medical enterprise.

• Conducts detailed billing and coding reviews in support of the UHealth/University of Miami/Miller School of Medicine Compliance Program as per the compliance review methodology, which is assigned and prioritized by the annual Compliance Audit Workplan and/or the Director of Billing Compliance.

• Generates and organizes review finding reports.

• Analyzes outcomes of reviews and proactively identify trends.

• Provides timely and concise feedback of reviews to the Compliance Manager (HB).

• Maintains current knowledge of changes in national and local coding and billing coverage decisions

• Represents the UHealth/University of Miami/Miller School of Medicine in an ethical and professional manner.

• Promotes compliance, best practices and solutions.

• Other duties as assigned.

Minimum requirements are an Associate degree or equivalent education, training and experience. Certification in medical coding (CHC, CCS, CPMA, RHIT through AHIMA or AAPC) preferred. Three years of experience in billing, coding and/or auditing of medical records. Experience reading remittance advices, particularly those generated by government-funded programs is helpful. Experience with electronic medical record systems (EMR) and in-depth knowledge and understanding of system documentation and coding processes. Must have an understanding of hospital billing, coding, medical terminology and documentation, regulatory compliance - including but not limited to procedural and diagnostic coding requirements. Knowledge of Medicare and Medicaid coding rules and guidelines; ICD-9/ICD-10/CPT/HCPCS, DRG coding rules, reimbursement methodologies including DRG, APC, CPT, HCPCS and documentation guidelines in an academic medical center preferred. Skillful in designing and maintaining spreadsheets using various databases and software applications with the ability to perform analysis based on data presented. Detail oriented with extensive knowledge of UB-04 claim form. Excellent communication (written and verbal) skills. Strong organizational, analytical, interpersonal and motivational skills required. Strong computer skills including Microsoft Office suite (i.e., Word, Excel, Access, PowerPoint) and other web-based applications.

Any appropriate combination of relevant education, experience and/or certifications may be considered.

UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for. The University of Miami offers competitive salaries and a comprehensive benefits package including medical and dental benefits, tuition remission, vacation, paid holidays and much more. The University of Miami is an Equal Opportunity/Affirmative Action-Veteran/Disability Employer. Come join us!

Patient safety is a top priority. As a result, during the Influenza (the flu) season (September through April), the University of Miami School of Medicine requires all employees who provide ongoing services to patients, work in a location (all Hospitals and clinics) where patient care is provided, or work in patient care or clinical care areas, to have an annual influenza vaccination. Failure to meet this requirement will result in rescinding or termination of employment.

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University of Miami
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A private research university with more than 15,000 students from around the world, the University of Miami is a vibrant and diverse academic community focused on teaching and learning, the discovery of new knowledge, and service to the South Florida region and beyond.

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