Job ID: 289466 Location: Augusta University Full/Part Time: Full Time Regular/Temporary:
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About Us
Augusta University is Georgia's innovation center for education and health care, training the next generation of innovators, leaders, and healthcare providers in classrooms and clinics on four campuses in Augusta and locations across the state. More than 10,500 students choose Augusta for educational opportunities at the center of Georgia's cybersecurity hub and experiential learning that blends arts and application, humanities, and the health sciences. Augusta is home to Georgia's only public academic health center, where groundbreaking research is creating a healthier, more prosperous Georgia, and world-class clinicians are bringing the medicine of tomorrow to patient care today. Our mission and values https://www.augusta.edu/about/mission.php make Augusta University an institution like no other.
Augusta University's distinct characteristics in education and research include real-world experiences and community engagement, as well as a culture of building community, corporate and government partnerships that address health, security, economic and societal concerns locally and across the state.
The University System of Georgia https://www.usg.edu/hr/orientation/welcome_to_the_board_of_regents_university_system_office is comprised of our 26 institutions of higher education and learning as well as the System Office. Our USG Statement of Core Values are Integrity, Excellence, Accountability, and Respect. These values serve as the foundation for all that we do as an organization, and each USG community member is responsible for demonstrating and upholding these standards. More details on the USG Statement of Core Values and Code of Conduct are available in USG Board Policy 8.2.18.1.2 and can be found online at https://www.usg.edu/policymanual/section8/C224/#p8.2.18_personnel_conduct.
The Dental College of Georgia at Augusta University, we provide dental education to the next generation of professionals by offering hands-on education through innovative research, patient care, and service. Join other dental providers to improve the oral health of Georgia and beyond. The DCG was founded to provide the people of Georgia with quality dental care by educating students in dentistry. As a patient, you have the option to receive treatment in one of our three different practice models consisting of student clinics, resident care, or in the faculty practice. All dental treatments can be completed by the specialists in our facility. We also serve patients in more than 20 clinics across Georgia.
Job Summary
The DCG Billing Compliance Analyst will conduct internal billing and documentation audits and compliance investigations; produce audit reports and findings with viable recommendations, monitor internal compliance reports.
Responsibilities
The duties include, but are not limited to:
AUDITING & MONITORING: Performance of interim, and annual billing, documentation audits across multiple dental and medical specialties and programs for faculty, resident and student providers to identify potential compliance risks and assist with the development of corrective action plans.
Monitor and analyze missing charge and procedure reports, communicate and coordinate with Program Directors on chart deficiencies, verify chart updates. Monitor and analyze corrective action plans to ensure DCG billing operations are aligned with DCG and Augusta University policies and adhere to contractual (commercial insurance), federal, state, local, regulatory documentation, coding and billing requirements.
EDUCATION & TRAINING: Provide periodic training to providers and employees on DCG and Augusta University compliance policies to include but not limited to contractual (commercial insurance); regulatory (e.g. False Claims Act, Stark Laws, Anti-Kickback Statutes) for billing, coding, and documentation referrals, and contracts.
REPORTING: Prepare and submit annual and interim audit reports. Maintain detailed records of audit and monitoring activities for reporting to the Director of Regulatory Compliance. Analyze audit data to identify trends to aid in developing recommendations for training or corrective action plans
INVESTIGATIONS: Conduct investigations of potential compliance violations using the University System of Georgia (USG) investigation guidance. Perform root cause analyses. Prepare reports in accordance with USG and AU protocols and standards.
PROFESSIONAL DEVELOPMENT: Maintain current and applicable knowledge of payor billing rules, federal and state documentation and billing laws and industry standards, CDT, CPT, ICD-10-CM, and HCPCS coding guidance through attendance of conferences, webinars, and other professional development activities
OTHER DUTIES: Perform all other job-related duties as assigned.
Required Qualifications
Bachelor's degree from an accredited college or university in healthcare or business-related field with two years of clinical or administrative experience in dental or medical healthcare environment as a certified coder with certification form the American Academy of Professional Coders (AAPC), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Dental Assisting National Board (DANB) or American Health Information Management Association (AHIMA). Third-party and federal payor insurance background/experience and knowledge of coding, billing, documentation, and reimbursement criteria.
OR
Associate's degree from an accredited college or university in healthcare or business-related field with four years of clinical or administrative experience in dental or medical healthcare environment as a certified coder with certification form the American Academy of Professional Coders (AAPC), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Dental Assisting National Board (DANB) or American Health Information Management Association (AHIMA). Third-party and federal payor insurance background/experience and knowledge of coding, billing, documentation, and reimbursement criteria.
Preferred Qualifications
Master's degree from an accredited college or university in healthcare or business-related field.
Preferred Experience
Advanced knowledge of the Center for Medicare and Medicaid Services and other third-party payor coding, billing, and documentation criteria.
Four or more years of clinical or administrative experience in dental or medical healthcare auditing billing, coding, and documentation for professional claims across multiple specialties. Five or more years of experience in compliance auditing and monitoring roles. Certified in Healthcare Compliance (CHC) Knowledge of audit sampling methodologies.
Knowledge, Skills, & Abilities
KNOWLEDGE Knowledge of healthcare compliance concepts and applicability to audits and risk assessments Knowledge of Center for Medicare and Medicaid Services (CMS) reimbursement principles.
SKILLS Strong project management skills, along with the ability to take initiative and work independently.
ABILITIES Ability to maintain confidentiality.
Ability to define problems, collect data, establish facts, and draw valid conclusions Ability to effectively present information Ability to apply a systematic approach to problem-solving and troubleshooting.
Certifications/License
Certified coder with certification form the American Academy of Professional Coders (AAPC), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Dental Assisting National Board (DANB) or American Health Information Management Association (AHIMA).
Shift/Salary/Benefits
Conditions of Employment
All selected candidates are required to successfully pass a Background Check review prior to starting with Augusta University.
If applicable for the specific position based on the duties: the candidate will also need to have a credit check completed for Positions of Trust and or approved departmental Purchase Card usage.
Motor vehicle reports are required for positions that are required to drive an Augusta University vehicle.
For Faculty Hires: Final candidates will be required to provide proof of completed academic degree(s) as well as post-secondary coursework in the form of original transcript(s). Those candidates trained by a foreign institution will also be required to provide an educational/credential evaluation.
All employees are responsible for ensuring the confidentiality, availability, and integrity of sensitive [patient, student, employee, financial, business, etc.] information by exercising sound judgment and adhering to cybersecurity and privacy policies during their employment and beyond.
Other Information
This position is also responsible for promoting a customer-friendly environment and providing superior service to our patients, students, faculty, and employees. "Augusta University is a patient-and family-centered care institution, where employees partner every day with patients and families for success."
Augusta University is a tobacco-free environment, and the use of any tobacco products on any part of the campus, both inside and outside, is strictly prohibited.
Equal Employment Opportunity Augusta University is proud to be an equal opportunity employer welcoming applicants from underrepresented groups, including individuals with disabilities and veterans.
