Sr Billing Compliance Analyst Job

Children's Health - Medical Records Careers

Job Number: 51536

Location: Dallas, TX

Date Posted: 4-22-2017

Description:

POSITION SUMMARY:

The Sr. Compliance Billing Analyst is responsible for performing clinical department billing compliance audits to ensure compliance to Medicaid coding and medical records documentation standards. Although daily reporting will be to the Director, Compliance, this position will have direct access and work frequently with the Chief Compliance Officer and the Manager Billing Compliance and Nurse Audit. Interacts frequently with all levels of personnel within the organization and handles highly confidential organizational information. Contributes to departmental goals and objectives by reviewing Children’s Health patient billing practices against regulatory requirements. Assists with mitigating the risk of penalties and fines (which can be very material in amount) due to improper billing practices.

JOB PROFILE:

The following describes the basic position duties that an employee MUST be able to perform for this role. This information is intended to be descriptive of the key responsibilities of the position. The list of essential functions below DOES NOT identify all duties performed by any single person in the position.

Requires depth within a specialized, critical discipline and/or breadth of substantive professional knowledge that crosses disciplines within the professional field

Interprets internal/external business challenges and recommends best practices to improve products, processes or services

Leads others to solve complex problems; uses sophisticated analytical thought to exercise judgment and identify innovative solutions

General guidelines and references are used with some discretion. Projects are assigned with latitude for decision making and setting of priorities. Specific problems should be referred to supervisor for clarification of policies and procedures before proceeding.

Works independently, with guidance in only the most complex situations. Information is not easily identified and may be unrelated to, or appear to conflict with, actual problems.

Communicates difficult concepts and tactfully negotiates with others to adopt a different point of view

JOB SPECIFIC RESPONSIBILITIES:

Identify billing risk areas and formulate auditing/monitoring plans and approach to monitor controls and compliance in these identified risk areas.

Plans and conducts clinical department or operational area billing compliance audits by selecting a statistically valid sample of claims, collecting documents, analyzing standards, and reviewing charts to claims. Ensures statistical selections are validated and audit tally sheets are accurate. With minimal supervision, produces effective written reports that tactfully bring the focused department along to achieve a culture of compliance.

Analyze billing compliance audit findings, summarize, draw conclusions and formulate recommendations for management.

Coordinate with the Director, Compliance, hospital department or operational area personnel and other entity leadership to communicate and present findings. Assist in implementing action plans in response to billing audit findings.

Assist with development and deployment of education needed to address billing audit findings.

Assist with review, follow-up and resolution of various billing compliance inquiries.

Stay abreast of regulatory changes that impact Medicaid and Medicare billing. Participate in response and education needed as a result of such changes.

Exhibits guiding behaviors that reflect Children's Health's values and support the mission and the vision.

Maintains an environment that supports and encourages the adoption of Children's Health’s stated values.

Works diligently to foster a culture and climate of sensitivity to ethical and compliant behavior within the organization.

Other duties as assigned.

LICENSES and CERTIFICATIONS:

Coding Certification such as or similar to Certified Professional Coder (CPC), Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT), Certified Coding Associate (CCA), Certified Coding Specialist (CCS), Certified Outpatient Coding (COC), Certified Inpatient Coder (CIC).Required

Licensure as a registered or licensed vocational nurse by the State of Texas preferred

EXPERIENCE:

A minimum of five years experience in medical billing or chart auditing. Prior experience in auditing/monitoring medical records for proper documentation and billing compliance. Required

High level knowledge of Medicare and Medicaid billing rules, charge capture process, and payer requirements. Required

EDUCATION:

Four-year Bachelor's degree or equivalent experience required

Specific Knowledge, Skills and Abilities:

Maintain effectiveness when experiencing major changes in work responsibilities or environment; adjust effectively to work within new work structures, processes, requirements, or cultures.

Use appropriate interpersonal styles to establish effective relationships with customers and internal partners; interact with others in a way that promotes openness and trust and gives them confidence in one's intentions.

Develop and use collaborative relationships to facilitate the accomplishment of work goals.

Ensure that the customer perspective is a driving force behind business decisions and activities; craft and implement service practices that meet customers' and own organization's needs.

Develop and use collaborative relationships to facilitate the accomplishment of work goals.

Identify and understand issues, problems, and opportunities; compare data from different sources to draw conclusions; use effective approaches for choosing a course of action or developing appropriate solutions; take action that is consistent with available facts, constraints, and probable consequences.

Take prompt action to accomplish objectives; take action to achieve goals beyond what is required; be proactive.

Deal effectively with others in an antagonistic situation; use appropriate interpersonal styles and methods to reduce tension or conflict between two or more people.

Effectively manage one's time and resources to ensure that work is completed efficiently.

Accomplish tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.

Set high standards of performance for self and others; assume responsibility and accountability for successfully completing assignments or tasks; self impose standards of excellence rather than having standards imposed.

Assimilate and apply new job-related information in a timely manner.

Clearly convey information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message.


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