BJC Healthcare Sr. Compliance Specialist in Saint Louis, Missouri
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BJC Medical Group is a dynamic, multidisciplinary group with locations across the St. Louis metropolitan and outlying areas. The physicians, providers and staff of BJC Medical Group provide the highest level of care to thousands of patients every day.
The Quality and Compliance Department provides support to the strategic and operational objectives of BJC Medical Group practices is located in Town & Country, MO.
Conducts and coordinates reviews of BJCMG providers documentation to ensure accuracy of services billed. Prepares reports of findings to be presented to providers. Develops educational opportunities for new and existing providers giving instruction on federal and state regulations, documentation guidelines, and coding training in a way that ensures compliance with governmental regulations. Collaborates with departments in providing appropriate education to staff as it relates to compliance and privacy of protected health information.
Conducts and coordinates routinely scheduled reviews of BJCMG providers documentation involved with professional fee billing, for accuracy of coding and physical presence. These reviews consist of ambulatory E&M services and office procedures, as well as hospital admissions, subsequent visits, hospital procedures, and all other services performed by BJCMG providers. The coordinator will review medical record documentation to identify under-coded and up-coded services, prepare reports of findings, and meet with providers to provide education and training on accurate coding practices and compliance issues.
Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services. Monitor trends and develops education and training on accurate coding practices and compliance issues.
Independently interacts with providers regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation.
Develops training, instruction, and independently provides technical support to providers and coders, as appropriate, regarding coding compliance documentation, regulatory provisions, and third party payer requirements.
Interacts with government agencies/contractors, management, employees and others, as necessary, to ensure an understanding of the organizations compliance initiatives.
- High School Diploma or GED
- 5-10 years
- No Experience
Licenses & Certifications
Preferred Requirements and Additional JobInformation
- Business/HC Admin/related
Licenses & Certifications
Note: not all benefits apply to all openings
- Comprehensive medical, dental, life insurance, and disability plan options- Pension Plan*/403(b) Plan- 401(k) plan- Tuition Assistance- Health Care and Dependent Care Reimbursement Accounts-On-Site Fitness Center (depending on location)-Paid Time Off Program for vacation, holiday and sick time
*Pension does not apply to Memorial Hospital, Memorial Hospital East, Memorial Medical Group, Alton Memorial or Parkland Health Center
The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job.
Equal Opportunity Employer