Job Title: Billing Integrity Consultant
Location: USF Health
Job Code: 4729
Job Function: Health Care
Pay Plan: 21
Job Code/Title: 4729 / Billing Integrity Consultant
Career Band: F
A Billing Integrity Consultant, working within a USF compliance and quality improvement program, is responsible for educating professionals, monitoring compliance, and recommending appropriate corrective action with regard to billing, privacy and other regulated activities in an academic and/or clinical unit.
NATURE OF WORK:
This position typically reports to a Program Director or other appropriate administrator within the program. This position currently exists at USF Health in the Professional Integrity Office where its primary functions have focused on monitoring medical academic activities, such as physician billing compliance. Functions of the Professional Integrity Office have been expanded to address HIPAA Privacy and Security and all issues related to professional integrity. The Billing Integrity Consultant’s role requires employees to possess specialized knowledge, professional judgment in addressing confidential and sensitive information, and highly effective communication skills to interact with employees and managers at many levels of USF and affiliated institutions. This is professional administrative and analytical work which is directly related to the mission of the College, VP area and university, requiring the application of discretion and judgment on matters of significance with respect to billing/coding, HIPAA privacy and security, and professional integrity. As such, the duties of this position are intended to qualify for exempt status under the administrative duties exemption of the Fair Labor Standards Act.
EXAMPLES OF DUTIES:
The following list provides examples of the most typical duties for positions in this job class. Individual positions may not include all of the examples listed, nor does the list include all work that may be assigned to positions in this job class.
- Presents orientation and on-going billing integrity training services to faculty, students/residents, and staff regarding compliance with Federal, State and other rules and regulations, as well as USF, VP, College policies and procedures.
- Conducts reviews (monitoring) and analysis of clinical documentation and coding in order to evaluate if billing, coding, and documentation criteria have been met; performs quality assessments of documentation and coding reviews completed by staff; makes recommendations for process/quality improvements.
- Conducts on-site assistance and reviews of documentation, coding and charge capture processes by accompanying faculty/physicians during clinical activities.
- Staffs Helpline; investigates Reports of Potential Problems; assists departments in completing identified corrective actions.
- Performs risk analysis, monitoring, and reporting of compliance activities.
- Participates in investigating and resolving complaints of privacy violations.
- Researches via publications and web sites governmental regulations, Medicare, Medicaid and other payer rules and guidelines in order to: maintains current knowledge of appropriate billing procedures; assist faculty, residents and staff with billing questions and issues; and develop training materials.
- Serves as liaison between the program and staff involved in each department’s billing integrity plan. Works with professionals to identify and integrate best business practices.
- Maintains detailed records; develops reports summarizing documentation and coding reviews, as well as communication with internal and external sources. Maintains detailed logs of work performed related to Reports of Potential Problems.
- May develop specific educational modules on Professional Integrity topics, such as Code of Conduct, Professional Integrity Program, Privacy, Bloodborne Pathogens, and others.
- May be responsible for managing and ensuring timely execution of USF HIPAA Business Associate Agreements, and developing related policies/procedures for process.
MINIMUM QUALIFICATION REQUIREMENTS:
This position requires a Bachelor’s degree, with two years of experience in a healthcare, regulatory or other directly relevant position. For Professional Integrity Office- Preferred: Hold one of the following, or be able to obtain within 6 months of hire: Registered Health Information Administrator, Registered Health Information Technician, Certified Coding Specialist- Physicians, or Certified Procedural Coder.