Billing Compliance Analyst

Nicklaus Children's Hospital; Miami (FL); On-site; USD 85,000 - 110,000; Full time

Job summary

Nicklaus Children's Hospital in Miami, FL seeks a Billing Compliance Resource to monitor the Billing Compliance Program and ensure adherence to federal, state, and local regulations as well as internal policies. The role analyzes review outcomes, identifies trends, and develops CAPAs with actionable recommendations.

The candidate will conduct training, document education, and stay current on coding and billing changes.

Qualifications

• Bachelor's Degree required; CPC/CCS/RHIA/RHIT certification preferred.
• Experience with federal auditing regulations, including billing, coding and documentation requirements.
• Experience conducting data mining audits.

Responsibilities

• Analyzes Billing Compliance review outcomes and identifies trends and high-risk areas.
• Develops Billing Compliance audit activity and trends reports.
• Develops recommendations for CAPAs.
• Monitors and reports effectiveness of Billing Compliance training.
• Presents findings and education to improve billing/coding procedures.
• Documents training sessions and maintains records in case management system as part of CAPAs.
• Researches changes in national and local coding and billing procedures.
• Performs follow-up audits to ensure CAPAs.
• Supports review of RAC requests and other external recoupment requests.
• Collaborates with NCHS to identify process improvement strategies.

Skills

Billing compliance experience

HIM data analysis

Interdisciplinary teamwork

Independent work

Federal regulations knowledge

Data mining audits

Education

Bachelor's Degree

CPC

CCS

RHIA

RHIT

Tools

CERNER

Job 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.

Minimum Job Requirements

• 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

Department: COMPLIANCE-1000-910900

Job Status: Professional