Compliance Education Specialist

Job Req ID: 114336

Compliance Education Specialist

We are seeking a Compliance Education Specialist who will plan, manage and ensure the development and delivery of billing compliance education in accordance with the Office of Compliance Professional Fee Services Compliance Plan. Provides on-going training and support to physicians, non-physician practitioners, professional-fee billing staff, clinic staff, administrators, compliance auditors and other affected personnel on documentation and billing requirements. Use auditing and analysis techniques, determines the adequacy of medical records documentation, coding and billing for all providers across all clinical specialties. Routinely analyzes the compliance audit plan and risk-based audit results for assessment of training and education effectiveness. Oversees compliance education activities in accordance with the Professional-Fee Services Compliance Plan. Ensures real-time monitoring of regulatory based compliance education. Works in close collaboration with the clinical departments, revenue cycles, compliance, and others. Prepares reports for the Senior Director, Director, and clinical department leadership regarding the status or results of reviews and/or education and training.

Specific Duties & Responsibilities

• Assumes responsibility for developing and maintaining JHM Billing Compliance course training curricula content in accordance with CPT coding standards and Federal and State regulatory guidelines.

• Assumes responsibility for designing and delivering training, using a variety of teaching methods (i.e. on-line training, case simulation, and other emerging educational technologies) and managing workflows for preparing training materials, scheduling, and tracking attendance.

• Conducts training sessions for clinicians, professional fee coders and others on a regularly scheduled or ad hoc basis.

• Partners with peers to ensure compliance staff are trained on documentation, auditing, and education.

• Identifies training and education needs through compliance audit results prepared and reported.

• Prepares and revises as needed a Compliance training manual or job aides for routine and special training programs.

• Serves as Lead for compliance training and prepares and/or reviews all billing compliance training materials developed by clinical departments, revenue cycle, and others.

• Serves as a primary resource for documentation, coding, and regulatory guidelines.

• Performs independent audits on the adequacy of medical record documentation for professional fee charges by ensuring compliance with government regulatory guidelines (i.e. Centers for Medicare & Medicaid Services- CMS conditions of payment) and CPT coding standards.

• Performs as necessary, a second-level review of audit work completed by Auditors and Sr. Auditors/Trainers for quality assurance.

• Provides feedback to clinicians and/or coders on the results of medical record documentation reviews and gives targeted training as needed.

• Identifies trends in billing, coding and documentation errors that pose a compliance risk and recommends corrective action plans.

• Provides guidance and tools to assist departments and clinicians in developing corrective action plans to improve documentation practices, address compliance problems, or improve professional fee billing activities. Monitors implementation of corrective action plans.

• Researches and answers billing and documentation questions or problems received from faculty, other physicians, advanced practice practitioners, departments, coders, billing staff, and others to ensure compliance with specific payer regulations and Johns Hopkins Medicine policies and procedures.

• Regularly monitors billing problems and/or errors identified by each departments' professional fee billing office as potentially impacting compliance.

• Research and assists in the development of medical record documentation standards and requirements related to clinical services billing.

• Keeps current with third party regulations with emphasis on Medicare and Medicaid billing, teaching physician regulations, Current Procedural Terminology, ICD-10-CM Coding, and professional fee billing.

• Performs other compliance related activities as necessary.

Scope of Responsibility

• Knows the formal and informal departmental goals, standards, policies and procedures which include familiarity of other departments within the school/division.

• Is sensitive to the relationship of both people and functions within the department, the Clinical Practice Association and JHHS Compliance Office.

Decision Making

• On a regular and continual basis, exercises administrative judgment and assumes responsibility for decisions, consequences, and results having an impact on people, costs, and/or equality of service within the functional area.

• Routinely handles confidential patient information and sensitive financial information.

Authority

• Compliance Specialists may be asked to assist with training new staff or correcting the work of others.

• Identifies and suggests process and operational improvements.

Communications

• Exchanges non-routine information using tact and persuasion as appropriate requiring good oral and written communication skills.

Special Knowledge, Skills & Abilities

• Requires a detail-oriented individual with the ability to handle a high volume of multiple tasks and follow through to completion.

• Must be able to learn quickly and work independently to address a variety of complex issues.

• Must be flexible to adjust to the development and refinement of new processes and procedures.

• CPT and ICD-10 coding required, including coding from clinical documentation or auditing the coding of others.

• Extensive knowledge of Medicare regulations regarding teaching physicians, documentation guidelines, and other federal and state laws and regulations concerning clinical documentation, coding, and reimbursement required.

• Knowledge of related clinical and business practices, policies, and procedures for billing and collection of professional fee services, and audit processes preferred.

• Communication, analytical and organizational skills are essential.

• Proficient in Microsoft Word applications including Excel, Word, PowerPoint, Outlook or equivalent e-mail, and internet usage. Experience with Epic and other clinical information systems preferred. Must be self-motivated and comfortable working independently, as a team leader and as a team member.

• This description is a general statement of required major duties and responsibilities performed on a regular and continuous basis. It does not exclude other duties as assigned.

Minimum Qualifications

• Bachelor's Degree in health care-related or business-related field.

• A minimum of one professional coding certification (CCS-P, CPC, RHIA or RHIT) required by start date.

• Five years of auditing/billing compliance.

• Demonstrated training or teaching experience.

Preferred Qualifications

• Additional coding certifications.

• Seven (7) years of compliance education experience.

Classified Title: Sr. Billing Compliance Auditor

Job Posting Title (Working Title): Compliance Education Specialist

Role/Level/Range: ATP/04/PE

Starting Salary Range: $72,600 - $127,000 Annually ($99,800 targeted; Commensurate with experience)

Employee group: Full Time

Schedule: M-F 8:30A-5PM

Exempt Status: Exempt

Location: Hybrid/Mount Washington Campus

Department name: Office of Compliance: Prof Fee Services

Personnel area: School of Medicine

Total Rewards

The referenced base salary range represents the low and high end of Johns Hopkins University's salary range for this position. Not all candidates will be eligible for the upper end of the salary range. Exact salary will ultimately depend on multiple factors, which may include the successful candidate's geographic location, skills, work experience, market conditions, education/training and other qualifications. Johns Hopkins offers a total rewards package that supports our employees' health, life, career and retirement. More information can be found here: https://hr.jhu.edu/benefits-worklife/.

Education and Experience Equivalency

Please refer to the job description above to see which forms of equivalency are permitted for this position. If permitted, equivalencies will follow these guidelines: JHU Equivalency Formula: 30 undergraduate degree credits (semester hours) or 18 graduate degree credits may substitute for one year of experience. Additional related experience may substitute for required education on the same basis. For jobs where equivalency is permitted, up to two years of non-related college course work may be applied towards the total minimum education/experience required for the respective job.

Applicants Completing Studies

Applicants who do not meet the posted requirements but are completing their final academic semester/quarter will be considered eligible for employment and may be asked to provide additional information confirming their academic completion date.

Background Checks

The successful candidate(s) for this position will be subject to a pre-employment background check. Johns Hopkins is committed to hiring individuals with a justice-involved background, consistent with applicable policies and current practice. A prior criminal history does not automatically preclude candidates from employment at Johns Hopkins University. In accordance with applicable law, the university will review, on an individual basis, the date of a candidate's conviction, the nature of the conviction and how the conviction relates to an essential job-related qualification or function.

Diversity and Inclusion

The Johns Hopkins University values diversity, equity and inclusion and advances these through our key strategic framework, the JHU Roadmap on Diversity and Inclusion.

Equal Opportunity Employer

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

EEO is the Law

https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12ScreenRdr.pdf

Accommodation Information

If you are interested in applying for employment with The Johns Hopkins University and require special assistance or accommodation during any part of the pre-employment process, please contact the Talent Acquisition Office at jhurecruitment@jhu.edu. For TTY users, call via Maryland Relay or dial 711. For more information about workplace accommodations or accessibility at Johns Hopkins University, please visit https://accessibility.jhu.edu/.

Vaccine Requirements

Johns Hopkins University strongly encourages, but no longer requires, at least one dose of the COVID-19 vaccine. The COVID-19 vaccine does not apply to positions located in the State of Florida. We still require all faculty, staff, and students to receive the seasonal flu vaccine. Exceptions to the COVID and flu vaccine requirements may be provided to individuals for religious beliefs or medical reasons. Requests for an exception must be submitted to the JHU vaccination registry. This change does not apply to the School of Medicine (SOM). SOM hires must be fully vaccinated with an FDA COVID-19 vaccination and provide proof of vaccination status. For additional information, applicants for SOM positions should visit https://www.hopkinsmedicine.org/coronavirus/covid-19-vaccine/ and all other JHU applicants should visit https://covidinfo.jhu.edu/health-safety/covid-vaccination-information/.

The following additional provisions may apply, depending upon campus. Your recruiter will advise accordingly.

The pre-employment physical for positions in clinical areas, laboratories, working with research subjects, or involving community contact requires documentation of immune status against Rubella (German measles), Rubeola (Measles), Mumps, Varicella (chickenpox), Hepatitis B and documentation of having received the Tdap (Tetanus, diphtheria, pertussis) vaccination. This may include documentation of having two (2) MMR vaccines; two (2) Varicella vaccines; or antibody status to these diseases from laboratory testing. Blood tests for immunities to these diseases are ordinarily included in the pre-employment physical exam except for those employees who provide results of blood tests or immunization documentation from their own health care providers. Any vaccinations required for these diseases will be given at no cost in our Occupational Health office.

Hybrid: On-site 1-2 days a week