Senior Compliance Associate - Hospital Billing
About The Position
The Senior Compliance Associate - Hospital Billing reflects Northwestern Medicine’s mission, vision, and values, adheres to its Code of Ethics and Corporate Compliance Program, and complies with applicable policies, procedures, regulatory requirements, and accreditation standards. The position assists department managers and directors with implementation of all aspects of the NMHC Corporate Compliance Program and may lead key initiatives. The role responds to hospital billing compliance inquiries and concerns, supports and conducts investigations, and leads compliance reviews and follow-up related to hospital billing and inpatient services. It also coordinates regulatory inquiries, audits, and investigations; monitors compliance risks and regulatory changes; contributes to the annual Compliance Work Plan and compliance policies; facilitates compliance committees; and helps develop metrics for monitoring organizational compliance.
Requirements
- Bachelor’s degree or 6 to 8 years of compliance, clinical, or legal experience.
- Healthcare experience related to hospital inpatient services, which may include compliance, regulatory, legal, coding, billing, auditing, or clinical operations.
- Certified coder (e.g., RHIA, RHIT, CCS, CCS-P, or equivalent) or eligible.
- Proficiency in Microsoft Office applications, including Word, Excel, PowerPoint, and Access, and related business software.
- Strong written, verbal, and interpersonal skills, with the ability to communicate and collaborate effectively with stakeholders at all organizational levels.
- Ability to handle confidential and sensitive information with discretion and professionalism.
- Ability to convey complex information clearly, concisely, and professionally.
- Strong organizational, analytical, and problem-solving skills, with the ability to manage multiple priorities in a fast-paced environment.
Nice To Haves
- Registered Nurse (RN) with clinical auditing, compliance, utilization review, or nurse auditor experience to perform medical necessity reviews.
- Juris Doctor (JD), or related experience interpreting and applying state and federal healthcare regulations.
- Certified in Healthcare Compliance (CHC).
- Knowledge of both hospital and professional billing.
- Proficiency in Epic and MDAudit.
Responsibilities
- Respond to hospital billing compliance inquiries and concerns from multiple reporting mechanisms, including the Compliance Hotline; assess issues, provide guidance, triage matters to stakeholders, and document reports and resolutions.
- Conduct and support hospital billing compliance investigations by gathering and analyzing information, interviewing stakeholders as appropriate, identifying root causes, documenting findings, and recommending corrective action and process improvements.
- Lead compliance reviews and follow-ups related to hospital billing and inpatient services, including assessment of billing accuracy, coding compliance, documentation sufficiency, medical necessity, and compliance with state and federal requirements.
- Coordinate regulatory inquiries, audits, and investigations involving CMS, OIG, and other federal and state agencies; assist with medical record and claim reviews, clinical documentation quality assurance, and response preparation.
- Identify, assess, and monitor healthcare compliance risks across the health system; recognize emerging issues, recommend mitigation strategies, and elevate concerns to leadership.
- Monitor regulatory trends and changes affecting the health system and subsidiaries, and assess their organizational impact.
- Assist with development and implementation of the department’s annual Compliance Work Plan.
- Help develop and maintain compliance policies and procedures and provide policy-related guidance to individuals and departments.
- Coordinate and facilitate agendas and materials for compliance-related committees.
- Help develop department and organizational metrics to monitor compliance with rules, regulations, policies, and procedures.
- Perform other duties assigned by the department Manager, Director, or VP, Integrity.
Benefits
- Competitive benefits, including tuition reimbursement, loan forgiveness, and 401(k) matching.
- A range of benefits intended to support employees’ physical, emotional, and financial well-being and provide protection for unexpected life events. See the benefits information URL for details.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
