Senior Billing and Coding Compliance Analyst & Educator

UVA Health; Charlottesville (VA); On-site; USD 72,000 - 128,000; Full time

Benefits offered by this job

Medical, Dental, and Vision Insurance

Paid Time Off

Retirement Savings

Health Savings Plans and FSAs

Certification and education support

Generous paid time off

Job summary

UVA Health seeks a Sr Billing and Coding Compliance Analyst and Educator to ensure adherence to federal healthcare program requirements. The role involves investigations, reviews, and education across UVA Health entities and external vendors.

Reporting to the Director of Compliance and Privacy, you will implement risk assessments, collaborate with regulatory teams, and guide policy development to optimize clinician revenue while maintaining compliance with government payor rules.

Qualifications

• 9 years of direct compliance audit/investigation experience in a physician or hospital billing environment or similar.
• Experience in compliance hospital and physician billing.
• CPC or CCS or AHIMA certification required.
• Willingness to travel occasionally for meetings and programs.

Responsibilities

• Prepare annual risk assessment and compliance work plan.
• Conduct billing and coding investigations at UVA Health entities.
• Conduct and/or manage billing and coding reviews per the compliance work plan.
• Design and perform billing and coding education and training.
• Collaborate to capture operational risks and implement mitigation plans.
• Oversee external vendors/auditors performing reviews.
• Serve as primary contact for billing and coding questions and guidance.
• Develop policies and procedures for documentation, charge capture, coding, and entry.
• Assist with refunds of overpayments to Federal program payors.
• Prepare reports for compliance steering committees and recommend improvements.
• Support executives and clinical leadership to improve billing quality and optimize revenue.

Skills

CPC Certification

AAPC/CCS Certification

Healthcare Billing Compliance

Regulatory Compliance

Education

Bachelor's degree or equivalent experience

Job description

Company Description

UVA Health is a comprehensive academic health system that includes four hospitals across Charlottesville, Culpeper, and Northern Virginia, as well as the UVA School of Medicine, UVA School of Nursing, UVA Physicians Group, and the Claude Moore Health Sciences Library. With more than 1,000 inpatient beds and over 1 million outpatient encounters annually, UVA Health delivers high-quality, specialized care to patients across Virginia and beyond. The UVA School of Medicine, founded in 1819, is nationally recognized for its clinical and research excellence, supported by more than $200 million in grant funding and multiple research centers. UVA Health Children’s is ranked the No. 1 hospital for children in Virginia by U.S. News & World Report, with several specialties among the best in the country. Team members join a mission-driven organization focused on advancing medical knowledge and improving patient outcomes. Our footprint also encompasses 3 community hospitals and an integrated network of primary and specialty care clinics throughout Charlottesville, Culpeper, Northern Virginia, and beyond.

Role Description

Reporting to the Director of Compliance and Privacy, the Sr Billing and Coding Compliance Analyst and Educator is responsible for working to ensure that UVA Health complies with the laws and regulations governing Federal healthcare programs (e.g., Medicare, Medicaid). This position is responsible for managing and/or conducting UVA Health’s professional and facility billing and coding investigations and reviews and conducting post-review education for UVA Health billing providers and departments. The position monitors and collaborates with compliance and operational staff across UVA Health entities (e.g., UVA Medical Center, UVA Community Health, UPG) and any external vendors hired to conduct compliance reviews relating to billing investigations or compliance work plans.

• Works to prepare the annual risk assessment and compliance work plan.
• Conducts billing and coding-related investigations at UVA Health entities.
• Conducts and/or manages billing and coding reviews conducted pursuant to the Compliance and Privacy Office’s compliance work plan.
• Designs and performs billing and coding-related education and training.
• Collaborates with regulatory/compliance functions and staff throughout UVA Health to ensure that the compliance risk assessment captures operational risks and that mitigation plans are created and implemented as necessary.
• Manages (as applicable) billing and coding related reviews conducted by external vendors/auditors.
• Serves as the UVA Health Corporate Compliance and Privacy Office’s primary contact for billing and coding related questions and advice.
• Provides oversight and guidance to the development of policies and procedures surrounding documentation, charge capture, coding, and charge entry to ensure compliance with government and payer requirements and to ensure optimization of clinician revenue.
• Works with UVA Health departments to ensure timely refunds of any overpayments to Federal program payors.
• Prepares reports for the entity compliance steering committees, and recommends improvements / solutions, guidance, and remedies.
• Works in cooperation with the executive staff, physicians, and clinical department management to enhance billing quality in a manner that will ensure compliance with government regulations, payer requirements and optimize revenue for the clinical practice.
• Completes other projects and duties as assigned by Director and the Chief Corporate Compliance and Privacy Officer.

MINIMUM REQUIREMENTS

Experience: In lieu of a bachelor's degree, 9 years’ experience in direct compliance audit and/or investigation experience in a physician and/or hospital billing environment or similar setting required. Experience in compliance hospital and physician billing required.

Licensure: Certified Professional Coder (CPC), AAPC or Certified Coding Specialist (CCS), AHIMA, required.

Other similar coding certifications may be considered.

PHYSICAL DEMANDS

This is primarily a sedentary job involving extensive use of desktop computers. The job does occasionally require traveling some distance to attend meetings, and programs.

The pay range for this role is $71,988.80 - $127,890.00 annually. Individual compensation will be determined by the selected candidate's qualifications, previous work experience, and/or education.

• Comprehensive Benefits Package: Medical, Dental, and Vision Insurance
• Paid Time Off, Long-term and Short-term Disability, Retirement Savings
• Health Saving Plans, and Flexible Spending Accounts
• Certification and education support
• Generous Paid Time Off

The University of Virginia is an equal opportunity employer. All interested persons are encouraged to apply, including veterans and individuals with disabilities. Learn more about UVA’s commitment to non-discrimination and equal opportunity employment.