Implement and maintain compliance programs in accordance with the Office of Inspector General's work plan to reduce institutional and individual provider legal and financial risk through education and internal audits.
Educate providers regarding compliance with government regulations with special attention to Center for Medicare and Medicaid guidelines as they pertain to academic medical centers, HIPAA, and fraud and abuse with periodic updates.
Assist in performing an analysis of current situations and recommend priorities and goals for future clinic needs.
Identify coding and billing risk areas, conduct focused reviews, and implement corrective action as needed.
Conduct routine internal audits of provider documentation on a timely basis.
Collaborate with physicians and internal staff in the development of improved capabilities in the areas of documentation, coding, and compliance.
Review internal controls, policies, and procedures to ensure compliance with appropriate university, state, and federal guidelines and policies, sound business and finance practices, and overall clinical goals and objectives.
Respond promptly to external and internal concerns; implementing corrective actions as appropriate.
Communicate with Medicare/Medicaid carriers and third-party payers regarding policies and procedures.
Promote compliance initiatives with clinical faculty and administration.
Perform other related duties incidental to the work described herein.

Work requires organization, analytical and communication skills generally acquired through the completion of a Bachelor's degree program.
Four years of administrative experience to acquire competence in applying compliance, coding and auditing principles as they relate to insurance billing, collections, consulting, and other revenue cycle-related functions.
For technical coding, two of the four years of experience with DRGs and APR-DRGs are required.
Experience in formal teaching of coding is preferred.
RHIA or RHIT or CCS required.
For professional coding, specialty coding experience in surgical or E/M coding is preferred.
CPC or CCS or RHIT or RHIA or CPMA is required.

Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging.

Compliance Specialist

Key skills