Compliance Analyst III, Professional Billing

UTSW; Dallas (TX); Hybrid; USD 85,000 - 105,000; Full time

Benefits offered by this job

PPO medical plan

100% preventive care coverage

Paid Time Off

Retirement Programs TRS

Paid Parental Leave

Wellness programs

Tuition Reimbursement

PSLF Qualified Employer

Learn more about employee benefits

Job summary

UT Southwestern Medical Center in Dallas, TX, seeks a Compliance Analyst III to conduct complex billing and coding compliance audits, assess documentation and reimbursement requirements, and identify compliance risks. The role operates on a hybrid schedule with in-office days twice weekly and additional on-site as needed.

The successful candidate will bring 5 years in compliance, a Bachelor's degree in a related field, and a compliance certification.

Qualifications

• Bachelor's degree in related field required or equivalent experience.
• Minimum 5 years of professional experience in a compliance-related role.
• Certification in compliance enhances candidacy.

Responsibilities

• Lead and manage complex assurance/review projects with goals, timelines and quality metrics.
• Evaluate compliance controls and adherence to university policies and procedures.
• Prepare reports with evidence and defend findings and recommendations.
• Assist investigations of alleged breaches and support preventative actions.
• Maintain relationships with compliance staff and stay current on regulatory developments.

Skills

Team leadership

Project management

Auditing & compliance

Healthcare regulatory knowledge

Data analysis

Education

Bachelor's Degree in business or healthcare administration

Compliance Certification

Job 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
• 100% coverage for preventive healthcare-no copay
• 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
• Learn more about these and other UTSW employee benefits!

EXPERIENCE AND EDUCATION

Required

• 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.