Consultant, Revenue Cycle Regulatory and Compliance

HealthPartners; Minnesota; On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Retirement program

Tuition reimbursement

Employee assistance program

Job summary

Park Nicollet seeks a Revenue Cycle Regulatory and Compliance Consultant to ensure compliant billing across the system, covering facility and professional claims. You will lead regulatory reviews and maintain tracking tools, collaborating with Revenue Cycle, Legal, Compliance, IT and care group leaders to implement compliant processes.

The role requires translating complex CMS and payor requirements into actionable practices, maintaining timelines, and ensuring accuracy with strong communication

Qualifications

• Bachelor’s degree; or equivalent work experience.
• 3+ years working with healthcare revenue cycle or within other highly regulated processes.

Responsibilities

• Manage and coordinate system-wide regulatory and payor requirements to ensure compliant billing practices.
• Perform regular internal audit reviews to ensure compliant billing and reporting regulations are being followed.
• Create and maintain tools and databases for tracking projects and proactively review regulatory filings.
• Keep current on regulatory requirements, such as 855 enrollments and state data submission requirements.
• Collaborate with key stakeholders across Revenue Cycle, Legal, Compliance, IT, and care group leaders to analyze and interpret data and policy.
• Stay up to date on CMS, commercial payors, and federal/state legislation changes.

Skills

Excel

Analytical thinking

Problem solving

Communication skills

Attention to detail

Time management

Collaboration

Self-motivation

Education

Bachelor’s degree

Master’s degree

Tools

Microsoft 365

Job description

Park Nicollet is looking to hire a Revenue Cycle Regulatory and Compliance Consultant to join our team!Come join us as a Partner for Good and help us make an impact on the care and experience that our patients and their families receive every day.

Position Summary:

Manage and coordinate system-wide regulatory and payor requirements to ensure compliant billing practices within revenue cycle. Perform regular internal audit reviews to ensure compliant billing and reporting regulations are being followed. Create and maintain tools and databases for tracking projects and proactively review regulatory filings. Keep current on regulatory requirements, such as 855 enrollments and state data submission requirements. Maintain time-sensitive processes and meet organizational deadlines. Collaboration with key stakeholders, including but not limited to Revenue Cycle teams, Legal, Compliance, IT, and care group leaders to analyze and interpret data and policy in efforts to identify solutions and resolve under minimal risk. Ability to stay up to date on policy and process changes with CMS, commercial payors, and federal/state legislation. This role is system-wide and may consist of both facility and professional claim types, including but not limited to rural health, critical access, and acute care, as well as MN/WI state variations.

Required Qualifications:

Education, Experience or Equivalent Combination:

• Bachelor’s degree; or equivalent work experience
• 3+ years working with healthcare revenue cycle or within other highly regulated processes.

Knowledge, Skills, and Abilities:

• Highly skilled with standard office computing applications such as Microsoft 365, especially Excel
• Ability to convert complex subject matter to accessible information for all colleagues
• Ability to self-motivate, take initiative and engage in critical thinking
• Excellent analytical and creative problem-solving abilities
• Task-oriented, with excellent follow through; patience and persistence.
• Excellent writing and communication skills
• Excellent organizational and time-management skills
• Strong commitment to accuracy and attention to detail
• Ability to work in a fast-paced environment, adapt to changing conditions, and meet deadlines
• Ability to work across departments with a collaborative, responsive, respectful approach
• Ability to become a trusted partner

Preferred Qualifications:

Education, Experience or Equivalent Combination:

• Master’s degree
• 2+ years’ experience with Medicare billing/regulatory experience
• 2+ years’ experience monitoring healthcare payor bulletins and legislative changes

Licensure/Registration/Certification:

• Healthcare Financial Management Association - Certified Revenue Cycle Representative (CRCR)

Knowledge, Skills, and Abilities:

• Ability to translate CMS billing regulations and requirements for acute care, critical access and rural health facilities into appropriate billing practice

Benefits:

Park Nicollet offers a competitive benefits package (for eligible positions) that includes medical insurance, dental insurance, a retirement program, time away from work, insurance options, tuition reimbursement, an employee assistance program, and much more!