Billing Compliance Analyst

Nicklaushealth; Miami (FL); On-site; USD 75,000 - 110,000; Full time

Job summary

Nicklaushealth is seeking a Billing Compliance professional to monitor regulatory adherence and analyze outcomes. You will identify trends, develop corrective actions, and collaborate to improve billing procedures across departments.

The role requires 4–7 years in billing compliance, with credentials such as CPC/CCS/RHIA/RHIT, and familiarity with Cerner. Excellent communication and teamwork are essential in a deadline-driven environment.

Qualifications

• Bachelor's degree required with healthcare data or billing experience.
• Certification CPC/CCS/RHIA/RHIT preferred for billing compliance work.
• Experience with federal, state, and payer billing rules and audits.

Responsibilities

• Monitor Billing Compliance activities for regulatory adherence.
• Analyze review outcomes; identify trends and high-risk areas.
• Develop CAPAs and provide training to staff on billing procedures.
• Prepare reports on audit activity and effectiveness of risk controls.
• Collaborate with teams to improve billing/coding processes.
• Research changes in national/local coding and billing decisions.
• Support RAC requests and other external recoupment inquiries.
• Maintain records of trainings and education provided.

Skills

Attention to detail

Analytical thinking

Communication skills

Team collaboration

Independent work

Education

Bachelor's Degree

Certified Coder 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