Compliance Analyst III, Health System

UT Southwestern Medical Center • Dallas, TX

7d • Hybrid

About The Position

Works under minimal supervision to manage and perform compliance assurance/effectiveness reviews of various functions and activities of UT Southwestern. Conducts complex assurance activities to determine departmental/unit/program adherence to internal controls, education/training requirements and compliance with established policies and procedures. The Compliance Analyst III conducts complex professional billing and coding compliance audits and reviews, including evaluation of medical record documentation, coding, billing, modifiers, medical necessity, and other reimbursement requirements. Evaluates provider billing practices for compliance with applicable federal and state requirements, payer requirements, and institutional policies and procedures. Performs risk-based and targeted reviews involving higher-risk professional billing areas, including evaluation and management services, procedural services, teaching physician requirements, split/shared services, incident-to billing, modifiers, time-based services, and other specialty-specific billing requirements. Analyzes claims, coding, reimbursement, and other data to identify trends, outliers, potential overpayments, and emerging compliance risks requiring further investigation or monitoring. This position is under a hybrid work schedule with two days per week in office and as needed.

Requirements

• Bachelor's Degree in business or healthcare administration, regulatory compliance, consulting, project management, or related area
• 5 years of professional experience in a compliance-related field.
• Work requires ability to evaluate data and determine compliance with rules and regulations
• Work requires excellent written and verbal communications skills.
• Work requires project management skills, including the establishment of goals, objectives while meeting project deadlines.
• Work requires skill in using spreadsheet applications, word processing, and database computer applications.

Nice To Haves

• Compliance Certification

Responsibilities

• Serves as team leader and project manager while conducting complex assurance/effectiveness reviews or other department projects, including the establishment of goals, objectives, timelines and quality measures for the team's work and deliverables.
• Conducts complex assurance/effectiveness reviews of compliance activities in accordance with appropriate standards, metrics, established compliance plan(s) and prescribed departmental/unit/program policies.
• Evaluates effectiveness of compliance controls used by reviewed department/unit/program, as well as compliance with all applicable university policies and procedures.
• Prepares compliance reports and is capable of providing supporting evidence and defend the findings and recommendations made regarding identified compliance deficiencies or gaps.
• Assists in investigations of alleged breaches of policy, misconduct or other acts of non-compliance to determine the cause, extent of loss and mechanisms for prevention.
• Maintains effective working relationships with compliance personnel to achieve objectives of assurance-related assignments.
• Remains abreast of current developments in compliance.
• Develops and maintains compliance-related education and training materials and, when necessary, conducts training sessions on compliance-related topics.
• Performs other duties, as assigned.

Benefits

• PPO medical plan, available day one at no cost for full-time employee-only coverage
• 100%25 coverage for preventive healthcare-no copay
• Paid Time Off, available day one
• Retirement Programs through the Teacher Retirement System of Texas (TRS)
• Paid Parental Leave Benefit
• Wellness programs
• Tuition Reimbursement
• Public Service Loan Forgiveness (PSLF) Qualified Employer

What This Job Offers

• Job Type: Full-time
• Career Level: Senior