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Senior Coding Compliance Specialist, ACO - REMOTE
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Full-time
Remote
- POSITION SUMMARYUnder the direction of the Chief Compliance & Privacy Officer and the Director of Compliance & Audit, the ACO Compliance Specialist will coordinate and support compliance functions and activities in support of enabling Sound Long-Term Care Management Accountable Care Organization (SLTCM-ACO) providers to comply with all applicable billing and privacy compliance regulations.
- ESSENTIAL DUTIES AND RESPONSIBILITIES Perform complex coding and documentation compliance reviews of SLTCM-ACO partners in the Nursing Facility, Post-Acute Care, and Telemedicine settings using applicable rules, regulations, and coding conventions for billing to determine the accuracy of coded and billed services, including APP services where applicable.
- Report and review audit findings with Chief Medical Officer, Value Based Care for SLTCM-ACO and the Chief Compliance & Privacy Officer on a regular basis to identify trends, issues, and potential risk areas.
- Be responsible for auditing records for providers in the ACO who provide the following types of services: SNF, NF, Behavioral Health, Wound Care, Infectious Disease, Annual Wellness Visits, Chronic Care Management visits, and Telemedicine.
- Create and provide education to site leadership and directly to providers around CPT coding and billing related to the ACO.Communicate directly with site leadership, ACO leadership, and ACO participating providers to answer questions related to audited encounters and CPT coding and billing for ACO services.
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