Senior Compliance Coding Analyst - Business Practices (Medical Center)

Houston Methodist•Houston, TX

About The Position

FLSA STATUS Exempt QUALIFICATIONS EDUCATION Associate's degree Bachelors degree preferred EXPERIENCE Four years of experience in billing compliance Experience working in teaching environment preferred LICENSES AND CERTIFICATIONS Required Preferred CPC - Certified Professional Coder (AAPC) or RHIA - Registered Health Information Administrator (AHIMA) or RHIT - Certified Health Information Technician (AHIMA) or CHRC - Certified in Healthcare Research Compliance (HCCA) or CCS-P - Certified Coding Specialist Physician-based (AHIMA) or CPC-H - Certified Professional Coder - Hospital (AAPC) or CPC-I - Certified Professional Coder Instructor (AAPC) SKILLS AND ABILITIES Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles Strong analytical and interpersonal skills Effective decision-making skills Ability to effectively work and communicate across all levels of the organization Ability to adapt to a rapidly changing environments and to adjust to new requirements Demonstrated sound judgment in applying and interpreting policies, procedures, laws, rules and regulations applying to compliance and monitoring ESSENTIAL FUNCTIONS PEOPLE ESSENTIAL FUNCTIONS Collaborates with revenue integrity teams to review provider services and provide effective education and feedback. Coordinates revenue cycle physician feedback meetings and other meetings as needed. Effectively and proactively communicates with all stakeholders to resolve issues and discrepancies in a timely manner. Actively participates in meeting and huddles using positive communication and makes positive contributions that contribute to department success. Mentors more junior team members and supports the training and onboarding of new staff. SERVICE ESSENTIAL FUNCTIONS Conducts risk-based and baseline reviews of complex and escalated claims or records in a timely manner, evaluates corrective actions and processes applicable refunds within established timeframes of communication to provider and/or department. Coordinates with appropriate stakeholders to provide feedback regarding documentation and billing practices as well as potential risk areas with electronic medical record. Provides periodic status reports of risk-based audit outcomes. Provides education as appropriate regarding department specific practices. Serves a subject matter expert. Effectively communicates audit results to faculty and staff. QUALITY/SAFETY ESSENTIAL FUNCTIONS Performs billing compliance reviews that meet department quality standards. Interprets and communicates potential revenue loss associated with incorrect coding or application of coding guidelines. Identifies potential risk areas and/or revenue potential through audit process. Communicates information to faculty, staff and residents through newsletters or webinars. FINANCE ESSENTIAL FUNCTIONS Utilizes resources effectively and efficiently, demonstrating responsible financial stewardship. Manages own time effectively and prioritizes work to achieve maximum results in a timely manner. Identifies, prioritizes and conducts reviews based on data analytics. Coordinates with appropriate stakeholders to identify and capture potential revenue opportunities. Verifies that accurate and concise claims are being billed to patients and third-party payers. Performs quality assurance. GROWTH/INNOVATION ESSENTIAL FUNCTIONS Proactively stays up-to-date on compliance coding industry and practices. Shares learnings with team. Proactively manages own professional development. Completes My Development Plan. SUPPLEMENTAL REQUIREMENTS WORK ATTIRE Uniform: No Scrubs: No Business professional: Yes Other (department approved): No ON-CALL Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Events, etc) regardless of selection below. On Call No TRAVEL Travel specifications may vary by department May require travel within the Houston Metropolitan area Yes May require travel outside Houston Metropolitan area No

Requirements

Associate's degree
Four years of experience in billing compliance
Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
Strong analytical and interpersonal skills
Effective decision-making skills
Ability to effectively work and communicate across all levels of the organization
Ability to adapt to a rapidly changing environments and to adjust to new requirements
Demonstrated sound judgment in applying and interpreting policies, procedures, laws, rules and regulations applying to compliance and monitoring
CPC - Certified Professional Coder (AAPC) or RHIA - Registered Health Information Administrator (AHIMA) or RHIT - Certified Health Information Technician (AHIMA) or CHRC - Certified in Healthcare Research Compliance (HCCA) or CCS-P - Certified Coding Specialist Physician-based (AHIMA) or CPC-H - Certified Professional Coder - Hospital (AAPC) or CPC-I - Certified Professional Coder Instructor (AAPC)

Nice To Haves

Bachelors degree preferred
Experience working in teaching environment preferred

Responsibilities

Collaborates with revenue integrity teams to review provider services and provide effective education and feedback.
Coordinates revenue cycle physician feedback meetings and other meetings as needed.
Effectively and proactively communicates with all stakeholders to resolve issues and discrepancies in a timely manner.
Actively participates in meeting and huddles using positive communication and makes positive contributions that contribute to department success.
Mentors more junior team members and supports the training and onboarding of new staff.
Conducts risk-based and baseline reviews of complex and escalated claims or records in a timely manner, evaluates corrective actions and processes applicable refunds within established timeframes of communication to provider and/or department.
Coordinates with appropriate stakeholders to provide feedback regarding documentation and billing practices as well as potential risk areas with electronic medical record.
Provides periodic status reports of risk-based audit outcomes.
Provides education as appropriate regarding department specific practices.
Serves a subject matter expert.
Effectively communicates audit results to faculty and staff.
Performs billing compliance reviews that meet department quality standards.
Interprets and communicates potential revenue loss associated with incorrect coding or application of coding guidelines.
Identifies potential risk areas and/or revenue potential through audit process.
Communicates information to faculty, staff and residents through newsletters or webinars.
Utilizes resources effectively and efficiently, demonstrating responsible financial stewardship.
Manages own time effectively and prioritizes work to achieve maximum results in a timely manner.
Identifies, prioritizes and conducts reviews based on data analytics.
Coordinates with appropriate stakeholders to identify and capture potential revenue opportunities.
Verifies that accurate and concise claims are being billed to patients and third-party payers.
Performs quality assurance.
Proactively stays up-to-date on compliance coding industry and practices.
Shares learnings with team.
Proactively manages own professional development.
Completes My Development Plan.