Senior Billing Compliance Analyst

Saint Francis Hospital, Inc.; United States; Remote; USD 90,000 - 120,000; Full time

Job summary

Saint Francis Hospital, Inc. is seeking a Senior Billing Compliance Analyst to support the system’s billing compliance program.

The role involves audits, data analytics, and leading prevention strategies in collaboration with compliance, coding, revenue cycle, and clinical teams. The candidate should have 5+ years in healthcare billing, coding, or compliance, and expertise in ICD-10-CM, CPT, HCPCS, CMS guidelines, and Epic systems.

Qualifications

• Advanced knowledge of ICD-10-CM, CPT, HCPCS, and billing regulations.
• Understanding CMS guidelines and OIG work plan focus areas.
• Experience with Epic and charging workflows.

Responsibilities

• Conducts and manages hospital and professional billing compliance audits, reviews, projects and investigations.
• Ensures reports are organized, accurate, and professional in content and presentation.
• Identifies significant issues within audit scope ensuring compliant billing practices.
• Develops ongoing billing compliance training and awareness initiatives.
• Monitors regulatory developments and analyzes related publications.
• Develops billing compliance documents with stakeholder input and approvals.
• Analyzes data to identify risks and draw conclusions from audits and investigations.
• Manages Billing Compliance Program policy and procedures lifecycle.

Skills

ICD-10-CM CPT HCPCS

CMS guidelines

OIG focus areas

Epic knowledge

Data analysis

Communication skills

Education

Bachelor's degree in Business, Healthcare Administration, or Health Information Management

Tools

Epic

Charge router

Microsoft 365

Job description

Full Time Days Must have RECENT (last 3-5 years) Epic HB or PB Billing Compliance experience.

Job Summary

The Senior Billing Compliance Analyst provides advanced support to the health system’s billing compliance program by performing complex audits, leading data analytics activities, and guiding prevention and monitoring strategies. This role serves as a subject matter expert on billing, charging, and coding compliance, collaborating with operational leaders, compliance leadership, coding teams, revenue cycle, and clinical departments. The senior analyst leads audit initiatives, identifies systemic risk areas, supports investigations, develops training content, advises on regulatory changes, and recommends process improvements that enhance compliant billing practices across the organization.

Minimum Education

• High school diploma or GED.
• Bachelor’s degree in Business, Healthcare Administration, or Health Information Management, preferred.

Licensure, Registration and/or Certification

None. Certified Healthcare Compliance (CHC) from the Healthcare Compliance Association (HCCA), preferred.

Work Experience

• Minimum 5 years of experience in Healthcare Billing, Coding, or Compliance.
• Audit Process and Data Analysis experience, preferred.

Knowledge, Skills, and Abilities

• Advanced knowledge of 10th Revision of the International Classification of Diseases (ICD-10-CM), Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding Systems (HCPCS) coding systems, guidelines, and federal/state billing regulations.
• Strong understanding of Center for Medicare and Medicaid Services (CMS) billing guidelines, Office of the Inspector General (OIG) work plan focus areas, and payer-specific policies.
• Advanced knowledge of Epic, charge router logic, clinical workflows, and charging methodologies.
• Knowledge of Microsoft 365 and other applicable software.
• Excellent communication skills, both written and verbal that present clear and concise information. Ability to present complex information to leadership.
• Strong data analysis capabilities, including the ability to work with large datasets, financial modeling, and root-cause analysis.

Essential Functions and Responsibilities

• Conducts and manages Hospital and Professional billing compliance audits, reviews, projects and investigations.
• Ensures that all written reports and correspondences are organized, accurate, appropriate in content, professional in appearance and effectively conveys the reported issue.
• Identifies significant issues within scope of the audit/review/project/investigation ensuring billing compliance with appropriate statutes, rules and regulations.
• Develops on-going billing compliance training and awareness initiatives.
• Analyzes and evaluates information related to the regulatory healthcare environment by monitoring the appropriate state, federal and industry websites, publications, and journals.
• Develops billing compliance related documents including stakeholder input, review, and approval.
• Analyzes and evaluates data, identifies risks, and makes appropriate conclusions based on audit test work, investigations, and project analysis.
• Manages the Billing Compliance Program Policy and Procedures life cycle process.
• Provides subject matter expertise by recommending updates to policies and procedures, best practices, and implementation guidance.

Decision Making

Independent judgment in making decisions involving non-routine problems under general supervision.

Working Relationships

• Coordinates activities of others (does not supervise).
• Coordinates and leads others in same work performed (does not supervise).
• Works directly with patients and/or customers.
• Works with internal and/or external customers via telephone or face to face interaction.
• Works with other healthcare professionals and staff.
• Works frequently with individuals at Director level or above.

Special Job Dimensions

None.

Supplemental Information

This document generally describes the essential functions of the job and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.

Location

Patient Accounting - Yale Campus Location: Virtual Office, Oklahoma 73105

Equal Opportunity Statement

EOE Protected Veterans/Disability

Company Overview

Saint Francis is a Catholic, not-for-profit Health system based in Tulsa, Oklahoma. We are the largest private employer in Eastern Oklahoma with over 12,000 employees, including 1,000 physicians. The health system is anchored by the 1,112-bed Saint Francis Hospital, the largest hospital in Oklahoma and the 11th largest in the nation. Our system also includes hospitals in south Tulsa, Muskogee and Vinita, as well as 110 Warren Clinic locations from Monkey Island to McAlester, northeastern Oklahoma's only children's hospital, a level IV neonatal intensive care unit, a 168-bed heart hospital, and Tulsa's leading trauma and emergency center.