Billing Compliance Analyst

Miami Children’s Hospital; Miami (FL); On-site; USD 70,000 - 100,000; Full time

Job summary

Miami Children’s Hospital seeks a Billing Compliance Analyst to support the Billing Compliance Program. The role monitors activities to ensure adherence to federal, state, and local regulations and organizational policies, and to identify trends for remedial action.

The candidate will develop audit activity and CAPA recommendations, analyze outcomes, and provide guidance to improve billing and coding procedures. Team collaboration and record-keeping are essential.

Qualifications

• Bachelor's degree required.
• Certified Coder (CPC/CCS/RHIA/RHIT) preferred.
• 4–7 years in billing compliance or related fields.
• Knowledge of federal auditing regulations (billing, coding).
• Experience with data mining audits.

Responsibilities

• Analyses Billing Compliance review outcomes and identifies trends.
• Develops billing compliance audit activity and trends reports.
• Develops CAPA recommendations.
• Monitors and reports effectiveness of training.
• Presents findings and provides guidance to improve billing/coding procedures.
• Maintains training records in the case management system.
• Researches changes in coding and billing procedures.
• Performs follow-up audits.
• Supports RAC requests and external recoupment requests.
• Collaborates with NCHS members to identify process improvements.

Skills

Billing compliance

Auditing regulations

Data mining audits

Healthcare revenue cycle

Education

Bachelor's Degree

CPC

CCS

RHIA

RHIT

Tools

CERNER

Job description

Job Description - Billing Compliance Analyst (302144)

Job Description

Billing Compliance Analyst - 302144

Description

Job Summary

Serves as a resource to the NCHS Billing Compliance Program and is responsible for monitoring Billing Compliance activities to ensure compliance with federal, state and local regulations, and NCHS policies.

Job Specific Duties

• Analyzes Billing Compliance review outcomes and proactively identifies trends and high-risk areas.
• Develops Billing Compliance audit activity and trends reports.
• Develops appropriate recommendations for Corrective and Preventative Action (CAPAs).
• Utilizes innovative ideas and tools to enhance the operational effectiveness.
• Monitors, analyzes, and reports the effectiveness of Billing Compliance risk-based training.
• Presents findings and feedback in a helpful manner to appropriate parties and provides pertinent education and/or guidance to improve billing/coding procedures.
• Documents education provided to applicable parties and maintains records of training sessions in the case management system as part of the Corrective and Preventative Actions (CAPAs).
• Researches changes in national and local coding and billing coverage decisions: maintain current knowledge of appropriate billing procedures.
• Performs follow-up audits to ensure complete and appropriate CAPAs.
• Supports the review and analysis of Recovery Audit Contractors (RAC) requests and other external requests for recoupment.
• Works collaboratively with NCHS members to identify and recommend strategies for process improvement.

Qualifications

• Bachelor's Degree
• Certified Coder CPC, CCS, RHIA, or RHIT
• 4-7 years of experience related to billing compliance, patient financial services, revenue cycle, HIM services, health care data analyst, or other relevant experience
• Experience with federal auditing regulations, including billing, coding and documentation requirements
• Experience conducting data mining audits

Knowledge, Skills, and Abilities

• Experience with CERNER is preferred.
• Experience in conducting Hospital, Professional Fee Service, and Research billing and coding audits preferred.
• Demonstrated experience working as part of an interdisciplinary team.
• Able to work independently.
• Able to research, abstract and communicate federal, state and payer documentation, billing and coding rules and regulations.
• Ability to be flexible, multitask, and switch priorities as well as work comfortably in a deadline driven/productivity environment.
• Ability to prioritize, organize, plan, and implement services as well as handle multiple projects/problems simultaneously.
• Excellent written and verbal communication skills.
• Excellent time management and organization skills.
• Strong interpersonal, collaboration, and presentation skills.
• Able to use tact, diplomacy, discretion, and judgment.
• Able to maintain confidentiality of sensitive information.

Job

Professional