Senior Billing and Coding Compliance Analyst & Educator

The Rector & Visitors of the University of Virginia; Charlottesville (VA); On-site; USD 72,000 - 128,000; Full time

Benefits offered by this job

Comprehensive Benefits Package

Paid Time Off

Disability & Retirement plans

Education and Certification support

Job summary

UVA Health is seeking a Sr Billing and Coding Compliance Analyst and Educator to ensure adherence to federal healthcare program requirements. The role conducts investigations, supervises reviews, and provides post-review education for billing providers and departments across UVA Health entities.

Responsibilities include developing the annual risk assessment, managing external vendor reviews, designing training, and collaborating with compliance and clinical leadership to optimize clinician

Qualifications

• Bachelor's degree required.
• 9 years' experience in direct compliance audit and/or investigation in a physician/hospital billing environment or similar.
• Certified Professional Coder (CPC), AAPC or CCS, AHIMA certification required.

Responsibilities

• Conduct billing and coding investigations and reviews across UVA Health entities.
• Designs and conducts billing and coding education and training for providers and departments.
• Prepare annual risk assessment and compliance work plans; monitor and mitigate operational risks.

Skills

Billing compliance investigations

Education & training on billing

Regulatory collaboration

Education

Bachelor's degree

CPC/AAPC/CCS/AHIMA certification

Job 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.

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MINIMUM REQUIREMENTS

Education: Bachelor's degree required.

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.

Benefits

• 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

UVA Health is a world-class Magnet Recognized academic medical center and health system with a level 1 trauma center. 2023-2024 U.S. News & World Report "Best Hospitals" guide rates UVA Health University Medical Center as "High Performing" in 5 adult specialties and 14 conditions/procedures. We are one of 70 National Cancer Institute designated cancer centers. UVA Health Children's is named by 2023-2024 U.S. News & World Report as the best children's hospital in Virginia with 9 specialties ranked among the best in the nation. Our footprint also encompasses 3 community hospitals and an integrated network of primary and specialty care clinics throughout Charlottesville, Culpeper, Northern Virginia, and beyond.

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.