As the region's dedicated experts in exceptional musculoskeletal care, our doctors and staff at Lakeshore Bone & Joint Institute have served the orthopedic needs of northwest Indiana since 1968. With state-of-the-art facilities, we are dedicated to delivering the exceptional, compassionate care patients need to keep moving and keep enjoying their life.

　　SUMMARY / OBJECTIVE

　　The Quality and Compliance Lead is responsible for ensuring documentation, coding and billing guidelines are followed. This includes CMS, OIG and any applicable specialty societies ( i.e. AAOS, NASS)when submitting claims.

　　ESSENTIAL FUNCTIONS

　　Provides training with PM system utilization and all software, websites or portals related to revenue cycle to achieve optimal performance in work area.

　　Assist in monitoring quality standards to ensure compliance with coding rules and regulations.

　　Maintains policies and procedures for areas of responsibility.

　　Provides timely coding updates and relays information to management about coding changes, regulations, modifiers, or changes in specialty society, national or local coverage determinations.

　　Prepares audits following parameters recommended by CMS or the Office of Inspector General.

　　Reviews patient documents for accuracy to include but not limited to office visits, surgical, and non-surgical procedures.

　　Verify that all codes are current and active.

　　Ensure proper coding on provider documentation and reports incomplete documentation to provider and/or clinical staff.

　　Understand coding and reimbursement regulations and recognize the order in which services are billed to ensure maximum reimbursement, while still satisfying proper coding requirements, by reading various coding and insurance newsletters and websites.

　　Works all coding denial and reports trends to management.

　　Assists in charge entry, both surgical and office when needed based.

　　Understanding of NCCI edits, AAOC, NASS and ASSH Global Guidelines for all applicable insurance carriers.

　　Works with management in coordinating routine internal and/or external billing and coding audits.

　　Maintain confidentiality and compliance with HIPAA rules and regulations.

　　Maintains LBJI handbook policy and reports any violations to appropriate management.

　　Other duties as assigned.

　　COMPETENCIES

　　Effective leadership of team environment.

　　Proven track record in building and developing high performing teams.

　　Superior judgment and decision-making skills.

　　Strong ethics and a high level of personal and professional integrity.

　　Adaptive and flexible.

　　Effective communicator at all levels in the organization.

　　HIPAA compliance.

　　WORK ENVIORNMENT

　　Work is performed in an office environment. Involves frequent personal and telephone contact with patients, physicians, and other healthcare personnel. Work may be stressful at times. Interaction with others is constant and interruptive. It is possible work may involve interaction with injured or sick patients.

　　TRAVEL

　　Travel between Lakeshore Bone & Joint Institute locations is expected for this position when necessary.

　　QUALIFICATIONS

　　Medical Coding Certification.

　　High school diploma.

　　PREFERRED EXPERIENCE REQUIREMENTS

　　Minimum of 1-year experience in healthcare management.

　　REQUIRED SKILLS

　　Great attention to detail.

　　Strong analytical skills.

　　Time management, prioritization, and sense of urgency.

　　Strong oral, written and persuasive skills.

　　Maintain patient confidentiality.

　　PHYSICAL REQUIREMENTS

　　While performing the duties of this job, the employee may be required to sit and/or stand for prolonged periods, work longer than eight (8) hour shifts, and to work both day/evening shifts. Work may require hand dexterity as well as the need to reach, climb, balance, stoop, kneel, crouch, talk, and hear. While performing the responsibilities of the job, the employee is required to talk and hear. Specific vision abilities required by the job include close vision and the ability to focus. Reasonable accommodation can be made to enable people with disabilities to perform the described essential functions of the job.

　　Compliance:

　　All employees have a responsibility to comply with our organization’s policies and procedures, adhere to our Code of Conduct, complete required compliance training modules, and report any observations of non-compliance.

　　EEO Statement:

　　We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.