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University of Southern California Documentation and Reimbursement Specialist in Los Angeles, California

Documentation and Reimbursement SpecialistApplyOffice of Culture, Ethics and Compliance - Office of ComplianceLos Angeles, California

USC’sOffice of Compliancepromotes the university’s mission and strategic plan by helpingUSCfaculty and staff employees understand and comply with applicable laws, rules, and regulations.

The Office of Compliance atUSCis a resource for navigating university rules, regulations and ethical expectations. The Hospital Compliance department is seeking aDocumentation and Coding Specialistto be a part of a growing team. The Documentation and Coding Specialist will be responsible for investigating and responding to matters regarding complex coding, documentation, compliance and/or reimbursement; developing, planning and conducting comprehensive coding and/or documentation training for physicians and other staff; assisting with development and implementation of new related policies and procedures; functioning as quality assurance coordinator; conducting quality control studies of coded data and documentation to ensure compliance; participating in claims review process; overseeing design and revision of divisional billing forms; overseeing billing dictionary updates related toICD-10 andCPT-4 codes; and conducting inpatient and outpatient chart reviews. This individual will work closely with medical group administrators, faculty and/or hospital administrators, as appropriate.


  • Investigates, responds to and communicates information regarding complex coding, documentation, and/or compliance matters. Analyzes coding and/or documentation issues/questions from both a compliance and coding perspective. Performs research and provides recommendations for use of codes and/or documentation in a timely manner. Works closely with hospital administrators and faculty as appropriate, regarding complex coding/documentation issues.

  • Develops educational materials, plans and conducts comprehensive coding and/or documentation training for a highly regulated healthcare process based on training needs of employees. Provides compliance/documentation educational sessions for physicians and other staff. Provides coding and/or documentation expertise for all compliance issues.

  • Monitors and reviews coding accuracy, documentation and/or clinical status determinations to support professional fee coding.

  • Functions as quality assurance coordinator and technical support for coding/documentation and/or clinical necessity applications, education and references. Measures and maintains compliance standards for coding procedures. Conducts quality control studies of coded data and billed services to ensure compliance.

  • Assists with review, development, modification and implementation of compliance policies and procedures to achieve and maintain compatibility with billing requirements. Advises and instructs physicians and other providers regarding billing and documentation policies, procedures and regulations. Interacts with physicians and other providers to obtain clarification of conflicting, ambiguous or non-specific medical documentation.

  • Participates in the design and updates of billing forms and billing system dictionaries and/or coding documentation queries to ensure that allICD-10 andCPT-4 codes are up-to-date and/or documentation is accurate and complete from both compliance and reimbursement perspectives.

  • Performs chart reviews for professional fees and/or outpatient and inpatient services billed throughGECBand/or the hospital billing systems. Analyzes results and prepare formal reports with findings and recommendations. Facilitates and improves hospital staffs’ and/or physicians’ understanding of payor and regulatory requirements by providing feedback related to documentation information.

  • Performs other related duties as assigned or requested. The university reserves the right to add or change duties at any time.

We pride ourselves on being a GREAT PLACE TO WORK, and that begins with our employees! We offer a wide variety of benefits and programs that support our staff and their families, including:

· Benefits: Health, dental, and vision plans, tuition assistance for our employees and their families, paid time off, flexible spending accounts, 2:1 retirement plan contributions, child care centers, and up to $50,000 housing subsidy. And because we are a qualifying public service organization, you may qualify for Public Service Loan Forgiveness (PSLF) for educational loans. Please visit for additional information.

· Perks: Discountsto USC sportingevents, USC Bookstores,wireless plans, travel, accommodations, and local entertainment.

· Career Growth: We are the largest private employer in Los Angeles, offering tremendous development opportunities in multiple fields and industries.

Minimum Education: Associate's degree, Combined experience/education as substitute for minimum education

Minimum Experience: 3 years

Minimum Field of Expertise: Associate degree in Health Information Technology or related healthcare degree or Associate degree in Nursing or an accredited Registered Nurse Program as evidenced by licensure or certification in any of the following: RHT, RHIA, CCS, CPC-H, CPC, or CCS-P. Knowledge of medical terminology or equivalent recent training or education. Knowledge of auditing concepts and principles.

Basic knowledge of biology/anatomy/disease processes, laboratory test and uses, prescription medications and their respective guidelines. Experience working in a health setting reading and understanding clinical and hospital health records. Candidates should satisfy at least one set of the following:

  1. Certification in any one of the following: RHIT, RHIA, CCS, CPC-H, CPC, CCS-P. Intermediate Comprehensive knowledge of ICD-10-CM, CPT and HCPCS coding. Intermediate Comprehensive and coding both facility and professional services, utilizing ICD-10-CM, CPT and HCPCS.

  2. Clinical experience as a RN or LVN in a case management or case coordinator role with experience on patient status determinations, Interqual and documentation.

  3. Clinical background as a RN or LVN with experience in medical auditing in an acute care setting.

  4. Clinical experience as a RN or LVN with expertise of case delivery documentation and related medical record documentation in an acute setting.

Preferred Field of Expertise: Three years of coding quality, documentation, and provider or hospital compliance experience.

REQ20086819 Posted Date: 03/05/2020