Description

UW Medicine has an outstanding opportunity for a Hospital Billing Compliance Analyst.

UW Medicine Compliance Analysts are responsible for performing daily activities required to fulfill the goals, audit plans, work plans, initiatives, and duties related to a specific Compliance program element or content area.  Analysts conduct audits and/or analyze data, prepare reports pursuant to the unit’s audit plan, and participate in the development and implementation of follow-up education, outreach, and/or other corrective actions. Analysts contribute to compliance program development by maintaining data for unit reports, participating in the development and/or delivery of educational and outreach materials, and maintaining unit records.  Analysts maintain current knowledge of applicable laws and regulations and may contribute to the unit’s risk assessments and risk mitigation strategies.

The Hospital Billing Compliance Analyst is responsible for audits that assess the accuracy of documentation, coding, and billing against federal regulations (Medicare) and other laws and state laws and regulations that may apply.

The Hospital Billing Compliance Analyst collaborates with clinical and administrative staff throughout the enterprise to address and mitigate compliance risks.  Compliance Analysts also function as part of a unit team to accomplish unit goals and work cooperatively with other compliance staff and entity staff as needed to resolve shared issues and concerns. In addition, they may participate in committees, workgroups, or process improvement projects as assigned.

RESPONSIBILITIES

• Under general direction, analyze data, draft preliminary audit reports, and process final reports according to established protocol.
• Provide feedback and education on the results of audits and collaboratively establish corrective action plans.
• Review and appeal claim denials based on coding and medical necessity.
• Research documentation, coding, billing, and other related regulatory guidelines.
• Investigate billing and coding issues as related to inquiries, complaints, or audit results.
• Serve as a resource for current documentation, coding, billing and related regulatory guidelines. Develop and maintain detailed audit records, prepare accurate and timely reports, and generate statistical information as requested.
• Provide information to management for regularly scheduled reports and updates regarding audit progress and results.
• Exercise sound judgment in the interpretation and application of law, regulations, policies and procedures.
• Safeguard the confidentiality of sensitive information.
• Perform other related duties as assigned or required.

COMPETENCIES

Accountability
   Consistently delivers on commitments and promises;
   Sets own standards of excellence instead of waiting for standards to be imposed;
   Accepts responsibility for outcomes (positive or negative) of one’s judgments or actions; admits mistakes and refocuses efforts when appropriate;
   “Owns” organizational and higher-level leadership decisions.

Exercising Good Judgment
Follows established guidelines and policies when making decisions and demonstrates sound judgment in making decisions when there is no precedent/guideline.

Job Knowledge
Demonstrates technical/professional mastery of skills and knowledge required for the position.

Problem Solving
Considers problems from all perspectives, and thoughtfully and responsibly considers all relevant impacts and implications before deciding;
Makes effective and timely decisions, even when data are limited and without unnecessarily referring to others;
Recognizes who needs to be involved in decisions and engages them when appropriate.

Service Orientation
Demonstrates a sincere, positive attitude toward helping others and getting things done; doesn’t say “it’s not my job.”
 

Teamwork
Develops and promotes positive working relationships with colleagues;
Seeks out, listens to, and considers the ideas and opinions of others;
Works cooperatively with others to develop and implement programs and ideas;
Shares information and expertise with others to accomplish mutual goals;
Understands the impact of actions/decisions on other individuals/departments/stakeholders.

Requirements

MINIMUM REQUIREMENTS

• Bachelor’s degree in a Health Sciences discipline, Business administration, or related field AND at least five years of experience with hospital billing and coding operations or compliance.
• Professional Certifications: CPC, COC, CIC, CCS, CCS-P, RHIT, or RHIA.
• Hospital billing and coding operations or compliance.
• Coding, documentation, and reimbursement content area expertise in one or more of the following:  utilization management, medical necessity, inpatient coding, or outpatient coding.
• Extensive knowledge of ICD-10-PCS, ICD-10-CM, CPT and HCPCS coding principles and guidelines.
• Comprehensive knowledge of federal and state regulations related to documentation, coding and billing.
• Proficiency with MS Word and Excel.
• Excellent oral and written communication skills.
• Self-motivated, detail-oriented and highly organized skill set.
  
  Equivalent education/experience will substitute for all minimum qualifications except where there are legal requirements such as license/certification/registration.

DESIRED REQUIREMENTS

• Inpatient (billing/coding/documentation) experience.
• Experience in an academic healthcare environment.
• Proficiency with electronic medical records systems, databases, and related automated systems.
• Clinical experience including but not limited to LPN or RN licensure.
• Certified in Healthcare Compliance (e.g., HCCA/HCCB CHC certificate).
• Experience with auditing processes.