Compliance Analyst II

University of Rochester•City of Rochester, NY

1d•Onsite

About The Position

As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive. Responsibilities: Provides compliance oversight and support for assigned clinical specialties across URMC and Affiliates in accordance with the OIG and OMIG compliance program guidance. Evaluates adherence to coding and billing regulations and guidelines through review, research, and analysis. Serves as a compliance resource, developing and delivering comprehensive education and training. Conducts investigations, risk assessments, and regulatory monitoring to prevent and detect fraud, waste, and abuse, specifically addressing the DRA, NY SSL § 363-d, and 18 NYCRR SubPart 521. Requires a high degree of accuracy, professional judgment, and accountability, as errors can result in significant regulatory or financial penalties or reputational risk.

Requirements

Bachelor or Associate’s degree in a related field preferred. Equivalent combination of education, professional certification(s), and substantial relevant experience will also be considered
Minimum of 3 years of healthcare coding experience required to include. APG, APC, and/or DRG coding methodologies or professional coding and billing in specialty areas.
Experience in a direct or supporting role within healthcare compliance preferably within an integrated health system or Academic Medical Center or other comparable setting.
Strong communication, interpersonal, and public speaking skills required.
Ability to efficiently produce clear, concise, and complete written audit reports required.
Excellent analytical, organizational, and problem-solving skills required.
Demonstrated objectivity and critical thinking in analyzing situations; must be able to evaluate facts without bias and avoid unsupported assumptions required.
Ability to manage projects and effectively advise staff in a motivational and positive manner required.
Willingness to collaborate with others and to work as part of a team required.
Ability to maintain high discretion and confidentiality with sensitive information required.
Experience creating, editing, and manipulating data and documents using Microsoft Office required.
One of the following credentials are required: Registered Health Information Technologist (RHIT), Registered Health Informational Administrator (RHIA), Certified Coding Specialist (CCS or CCS-P), Certified Professional Coder (CPC), or Certified Outpatient Coder (COC) or equivalent professional certification.

Nice To Haves

Certified in Healthcare Compliance (CHC) preferred

Responsibilities

Analyzes billing data to identify potential risk areas related to professional and/or facility payment systems.
Performs audits of medical record documentation to ensure compliance with coding and billing requirements as defined by AMA, AHA, HCPCS, CMS and Medicaid guidelines.
Creates and provides reports on findings to relevant stakeholders.
Responds to reported compliance concerns by conducting formal investigative activities.
Assesses and documents allegations of non-compliance in the department’s case management system.
Plans and strategizes each investigation, collects and analyzes documents, data, electronic records, billing and clinical documentation, and other relevant materials.
Conducts interviews with reporters, witnesses, and implicated individuals.
Reviews facts in the context of applicable coding, billing, and regulatory requirements.
Performs root cause analysis when deficiencies are identified.
Collaborates with relevant stakeholders to determine improvement opportunities to mitigate future risk.
Collaborates with OIC leadership to determine corrective action such as formal self-disclosures or claim adjustments.
Develops and delivers comprehensive education and training sessions for faculty, residents, and staff, covering essential topics such as coding, compliance with Medicare, Medicaid, and third-party payer billing regulations, and fraud, waste, and abuse prevention.
Serves as a resource and subject matter expert for URMC and Affiliate personnel, offering guidance on billing, coding, and reimbursement matters.
Assists in due diligence activities related to physician practice and provider acquisitions as directed by OIC leadership and/or Office of Counsel.
Assists in assessing and responding to external audits and government investigations as directed.
Participates in special projects and investigations as directed by compliance leadership and/or Office of Counsel.
Maintains up-to-date knowledge of compliance risks by engaging in professional associations, networking with peers at other academic medical centers, reviewing relevant literature, and participating in industry seminars and educational events.
Performs other duties as assigned.