Analyst, Compliance

Responsibilities

• Provide oversight and perform, as needed, ongoing, risk-based, and ad hoc coding auditing of complex services, across multiple specialties, rendered by physician and non-physician practitioners using current coding guidelines, with attention to Medicare/Medicaid, medical necessity, and NCD/LCD requirements; including but not limited to retrospective audits for established providers and prospective audits for newly onboarded providers to ensure appropriate documentation, coding accuracy, and billing compliance.
• Manage departmental compliance teams under the leadership of the Sr. director and Chief Compliance Officer.
• Collaborate closely with the central revenue office and departmental compliance teams to address revenue and billing integrity needs.
• Support departmental compliance teams by providing advisory guidance and expert knowledge of CPT/HCPCS and ICD-10 guidelines across multiple specialties, as well as teaching facility guidance, professional fee billing, including global surgical package rules, modifier usage, incident-to services, split/shared services, and emerging regulatory changes.
• Assist with managing CUIMC’s annual compliance work plan.
• Assist with CUIMC’s annual education curriculum and monthly Compliance Forums ongoing education and training.
• Assist in the development and delivery of educational sessions related to coding, documentation, and payer-specific billing requirements for physicians and billing personnel.
• Collaborate with the central revenue office, clinical staff, providers, and administrative personnel to address compliance issues.
• Assist with development and management of compliance policies and procedures.
• Assist Compliance Leadership with other assignments and related compliance responsibilities as needed.

Requirements

• Bachelor’s degree or minimum four(4) years of direct experience in healthcare professional fee billing, coding, and/or compliance, preferably in an academic medical center or large healthcare system.
• Current credential of CPC/CCS-P or related coding professional credential required.
• Expert knowledge of Evaluation and Management (E/M) guidelines and surgical coding in multiple specialties with preference in orthopedics, surgery, and cardiology; and high-working knowledge in more.
• Epic electronic health record experience.
• Experience in using one or more audit tools, (e.g. Audit Manager, MDAudit, etc.).
• Excellent analytical skills and communication skills, both oral and written, including Microsoft Office advance proficiency.
• Excellent project management skills and time management.

Qualifications

• Must be self-starter, work autonomously, and self-disciplined.

Skills

• Excellent analytical skills and communication skills, both oral and written, including Microsoft Office advance proficiency.
• Excellent project management skills and time management.

Benefits

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to departmental budgets, qualifications, experience, education, licenses, specialty, and training.

Pay

Salary Range: $80,000 - $90,000

Schedule

Hybrid schedule position, which offers days working onsite and remote.