Senior Compliance Analyst

UW Health • Middleton, WI

11h • Hybrid

About The Position

This is a full-time, hybrid position with a scheduled work week of Monday - Friday, 8:00 am - 4:30 pm. The hours may vary based on department needs. The majority of the work can be done remotely with occasional onsite meetings. The role involves performing audits and providing guidance on professional and facility documentation and billing issues within UW Health and its affiliates. It also includes responding to external audits, understanding Medicare Clinical Trial policies, auditing coding and billing for clinical trials, identifying coding and billing risk areas, and implementing corrective actions. The analyst will ensure accurate coding by using official coding resources and manuals. They will interact with key stakeholders in Revenue Cycle, HIM, Risk Management, Quality, Legal, and others to ensure compliance with state and federal regulations. Additionally, the role involves continuous evaluation of the audit program, recommending improvements for efficiency, and developing standards for the audit process.

Requirements

• High School Diploma or equivalent and graduate of a Medical Coding Program Required
• Two (2) years of Coding experience may be considered in lieu of the medical coding program in addition to the experience below.
• 5 years of related coding or auditing experience in a health care setting Required
• Experience with third-party reimbursement and billing systems Required
• Certified Professional Coder (CPC) Upon Hire Required or Certified Coding Specialist (CCS) Upon Hire Required or Certified Inpatient Coder (CIC) Upon Hire Required or Certified Outpatient Coder (COC) Upon Hire Required or Certified Professional Medical Auditor (CPMA) Upon Hire Required

Nice To Haves

• Bachelor's Degree in a health care related field Preferred
• 7 years of multi-specialty physician/hospital coding and/or auditing experience in an academic medical center Preferred
• Experience interacting with physicians/hospital staff regarding compliance requirements Preferred

Responsibilities

• Perform audits and provide guidance on both professional and facility related documentation and billing issues within UW Health and for Affiliates and Joint Ventures
• Respond to external audits by reviewing findings and providing detailed verbal and written communications to third party payers.
• Understand Medicare Clinical Trial policies and be responsible for audits of coding and billing related to clinical trials conducted by UW Health staff across multiple specialties.
• Identify coding and billing risk areas, conduct focused reviews and implement corrective action as needed. Ensure accurate coding by utilizing official coding resources, Medicare and Medicaid manuals and policies and third-party payer resources.
• Interact with key stakeholders in Revenue Cycle, HIM, Risk Management, Quality, Legal and others when addressing compliance with state and federal regulations.
• Perform continuous evaluation of the audit program including, recommending changes or improvement to achieve audit efficiencies and recommending and developing standards to be utilized in the audit process.

Benefits

• health and dental insurance
• paid time off
• retirement plans
• two-week paid parental leave
• adoption assistance
• Options for a variety of schedules and shifts that offer flexibility and allow for work-life balance.
• Access to great resources through the UW Health Employee Wellbeing Department that supports your emotional, financial, and physical well-being.
• Tuition benefits eligibility
• The opportunity to earn a referral bonus for referring friends, former colleagues or others to apply for open, posted positions.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: High school or GED