Compliance Analyst III, Professional Billing

The University of Texas Southwestern Medical Center; Dallas (TX); Hybrid; USD 85,000 - 110,000; Full time

Benefits offered by this job

PPO medical plan

Paid Time Off

TRS Retirement Programs

Paid Parental Leave

Wellness programs

Tuition Reimbursement

PSLF Eligible Employer

Job summary

UT Southwestern Medical Center is seeking a Compliance Analyst III to perform complex billing and coding compliance audits, evaluating documentation, coding, and reimbursement requirements. This hybrid role combines in-office collaboration two days weekly with flexible on-site attendance as needed, supporting risk-based reviews and policy adherence across departments.

The ideal candidate has 5+ years in compliance, a Bachelor’s degree in a related field, and relevant certifications.

Qualifications

• Bachelor's degree in business, healthcare administration, regulatory compliance, or related area.
• Minimum 5 years of professional experience in a compliance-related field.
• Licenses and Certifications: Compliance Certification.

Responsibilities

• Serve as team leader and project manager for assurance/reviews with goals, timelines, and quality measures.
• Conduct complex compliance reviews against standards and policies.
• Evaluate effectiveness of compliance controls and company policies.
• Prepare reports with evidence and defend findings.
• Assist investigations into policy breaches and non-compliance.
• Maintain relationships with compliance personnel to achieve objectives.
• Stay updated on current compliance developments.
• Develop and maintain education and training materials; conduct trainings.
• Perform other duties as assigned.

Skills

Regulatory compliance

Auditing

Communication skills

Team leadership

Data analysis

Education

Bachelor's degree in healthcare administration

Job description

Job Description - Compliance Analyst III, Provider Billing and Coding (973653)

Job Description

Compliance Analyst III, Provider Billing and Coding - ( 973653 )

Description

WHY UT SOUTHWESTERN?

With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the number 1 hospital in Dallas-Fort Worth according to U.S. News & World Report , we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you'll discover a culture of teamwork, professionalism, and a rewarding career!

JOB SUMMARY

The Compliance Analyst III conducts complex professional billing and coding compliance audits and reviews, including evaluation of medical record documentation, coding, billing, modifiers, medical necessity, and other reimbursement requirements. Evaluate provider billing practices for compliance with applicable federal and state requirements, payer requirements, and institutional policies and procedures. Perform risk-based and targeted reviews involving higher-risk professional billing areas, including evaluation and management services, procedural services, teaching physician requirements, split/shared services, incident-to billing, modifiers, time-based services, and other specialty-specific billing requirements. Analyze claims, coding, reimbursement, and other data to identify trends, outliers, potential overpayments, and emerging compliance risks requiring further investigation or monitoring.

This position operates on a hybrid work schedule, with a minimum of two days per week in the office (Monday and Wednesday) and additional on-site attendance as business needs require.

BENEFITS

UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include:

• PPO medical plan, available day one at no cost for full-time employee-only coverage
• Paid Time Off, available day one
• Retirement Programs through the Teacher Retirement System of Texas (TRS)
• Paid Parental Leave Benefit
• Wellness programs
• Tuition Reimbursement
• Public Service Loan Forgiveness (PSLF) Qualified Employer
• Education
  Bachelor's Degree in business or healthcare administration, regulatory compliance, consulting, project management, or related area
• Experience
  5 years of professional experience in a compliance-related field.

Preferred

• Licenses and Certifications
  Compliance Certification

JOB DUTIES

• Serves as team leader and project manager while conducting complex assurance/effectiveness reviews or other department projects, including the establishment of goals, objectives, timelines and quality measures for the team's work and deliverables.
• Conducts complex assurance/effectiveness reviews of compliance activities in accordance with appropriate standards, metrics, established compliance plan(s) and prescribed departmental/unit/program policies.
• Evaluates effectiveness of compliance controls used by reviewed department/unit/program, as well as compliance with all applicable university policies and procedures.
• Prepares compliance reports and is capable of providing supporting evidence and defend the findings and recommendations made regarding identified compliance deficiencies or gaps.
• Assists in investigations of alleged breaches of policy, misconduct or other acts of non-compliance to determine the cause, extent of loss and mechanisms for prevention.
• Maintains effective working relationships with compliance personnel to achieve objectives of assurance-related assignments.
• Remains abreast of current developments in compliance.
• Develops and maintains compliance-related education and training materials and, when necessary, conducts training sessions on compliance-related topics.
• Performs other duties, as assigned.

SECURITY AND EEO STATEMENT

Security

This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.

EEO

UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.

UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. In accordance with federal and state law, the University prohibits unlawful discrimination, including harassment, on the basis of: race; color; religion; national origin; gender, including sexual harassment; age; disability; citizenship; and veteran status. In addition, it is UT Southwestern policy to prohibit discrimination on the basis of sexual orientation, gender identity, or gender expression.

Copyright 2017.The University of Texas Southwestern Medical Center5323 Harry Hines Blvd., Dallas, Texas 75390Phone [phone]