University of Rochester Compliance Analyst Auditor in Rochester, New York
Full Time 40 hours Grade 052 Compliance Office
8:30 AM-5 PM
- To support the Medical Center Compliance Plan by providing documentation, coding and billing training to physicians, non-physician practitioners and billing staff and by performing focused audits and reviews of professional and technical billing.
- To determine compliance with billing policies and procedures to ensure applicable laws are followed.
Under direction and supervision of the Chief Compliance Officer or a Compliance Analyst/Educator, as assigned, the Compliance Analyst/Auditor:
- Works with Compliance Analyst/Educators to train new physicians and non-physician practitioners regarding medical documentation, coding and billing;
- Performs reviews of medical record chart documentation, claims and billing to ensure compliance with applicable CPT, Medicare, Medicaid and commercial payer guidelines.Ensures chart documentation supports the selected billing code and level;
- Analyzes data to identify potential outliers and to assist in the process of identifying providers and services that warrant review;
- Produces timely, concise and well written reports regarding auditing activities.Makes recommendations for corrective action and is accountable for appropriate follow-up;
- Responds to questions from Medical Center personnel on billing, coding and reimbursement issues.
- Assists in investigations, special projects and due diligence activities as directed by the Chief Compliance Officer and Office of Counsel.Generates timely, concise analyses and reports;
- Responds timely to requests for assistance and education from Senior Analyst/Educators, chairs, practitioners, administrators, billing managers and other compliance program stakeholders;
- Assists in responding to external audits, government investigations and litigation as directed by the Chief Compliance Officer;
- Maintains current knowledge of healthcare reimbursement compliance issues through professional reading, and participation in seminars and programs;
- Is proactive in identifying and in proposing strategies for assessing and resolving risk.
A substantial portion of this individual’s time will be engaged in direct auditing and report writing activities. It is anticipated that over time as the individual gains experience and demonstrates the ability to act independently, that the individual will assume progressively greater responsibility for managing the compliance needs of individual clinical or hospital departments.
This is an exempt position. General office hours are 8:30 am to 5:00 pm, Monday through Friday with a 30 minute lunch break. However, the positon often requires presence for meetings at UR Medicine facilities before and after these hours to accommodate the clinical schedules of internal clients.
- Bachelor’s degree in a relevant field, or equivalent training and experience;
- At least 1-3 years relevant experience in healthcare billing, coding, medical record documentation, claims processing or medical record auditing;
- Strong communication, interpersonal and public speaking skills;
- Excellent analytical, organizational and problem solving skills;
- The ability to efficiently produce clear, concise and complete written audit reports;
- Willingness to follow directions, to collaborate with others and to work as part of a team;
- The ability to think critically, work independently, respond timely and prioritize work;
- The discretion and judgment to maintain highly confidential and sensitive information;
- Experience creating, editing and manipulating documents using Microsoft Excel and Microsoft Word;
- Experience working with electronic medical records systems and electronic billing systems.
One or more of the following:
- AAPC Certification as a Certified Professional Coder (CPC), Certified Professional Biller (CPB), Certified Professional Medical Auditor (CPMA), Certified Outpatient Coder (COC), or Certified Professional Compliance Officer;
- AHIMA certification as a Registered Health Information Technician or Registered Health Information administrator;
- CHC Certification in Healthcare Compliance (CHC) or as a Certified Compliance and Ethics Professional;
- Experience with UR Medicine health information management and billing systems (EPIC eRecord, ePARC, BAR and HPA billing systems or with McKesson Explorer).
EOE Minorities/Females/Protected Veterans/Disabled
Job Title: Compliance Analyst Auditor
Location: Health Sciences
Job ID: 212603
Full/Part Time: Full-Time