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Senior Compliance Analyst, Billing and Reimbursement Compliance

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Audit / Compliance
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134374 Requisition #
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The primary purpose of the Senior Compliance Analyst, Billing & Reimbursement Compliance position is to perform complex billing & reimbursement compliance investigations and provide education and training based on the results of investigations, as appropriate. Prepare reports as required. The Senior Compliance Analyst may perform routine billing & reimbursement provider audits and shall provide education based on the results of the routine audits, as appropriate.

 

Audits/Investigations/Special Reviews 

  • Independently conducts focused audits and investigations into information sensitive areas of suspected billing & reimbursement non-compliance.
  • Works collaboratively with other departments to obtain required documents and actively researches background information to develop a thorough understanding of the area being audited.
  • Independently conducts critical prospective and/or retrospective inpatient and outpatient professional and/or technical documentation audits of the institution’s professional and/or technical billing, identify problems, risk factors, and risk areas regarding compliance with applicable federal and state statutes, regulations, and guidelines set forth by regulatory agencies and third party payors, as well as The University of Texas System and the institution’s rules, guidelines, policies, procedures, and compliance plans.
  • Assists with identifying billing & reimbursement compliance issues to be audited. 
  • Prepares audit notifications and makes arrangements for conducting on-site audits.
  • Effectively identifies and quantifies billing compliance deficiencies and makes recommendations for corrective action plans.
  • Recommends changes to operational systems/practices in order to maintain compliance.
  • Effectively evaluates audits and investigation results with appropriate consideration of relevance and accuracy. Formulates conclusions and recommendations based on accumulated audit evidence.
  • Prepares timely, thorough, clear, and concise written reports of compliance audits and investigations.
  • Arranges and participates in Audit Findings Discussion Conferences with the billing professional and/or departments/teams to present audit and investigation findings and make recommendations for corrective action.
  • Communicates effectively with physicians, administrative staff, and other workforce members to ensure a successful audit.
  • Assesses audit responses provided by operational areas to determine appropriateness of the response. Makes recommendations for additional follow-up audits, if required.
  • Maintains appropriate and complete audit files and auditing databases.  Secures, indexes, and archives all documents for storage. Extracts information from databases to prepare various compliance reports.
  • Provides supervision to Associate Compliance Analysts’ audits and/or investigations as assigned.

  

Compliance Representative 

  • Works in close collaboration with other Institutional Compliance Office staff and/or other management teams throughout the institution to ensure program-wide compliance efforts are in alignment with federal, state, and institutional requirements for billing professional services and/or technical services.
  • Serves on Institutional Compliance Committees, Sub-Committees, and Work Groups as Assigned.

  

General Compliance Program Activities

  • Maintains working knowledge of new rules, regulations, and revisions, as set forth by CMS, the Medicare Administrative Contractor, and other entities regarding billing & reimbursement compliance. Communicates regulatory/policy updates to assist departments in maintaining acceptable billing & reimbursement compliance practices.
  • Participates in assignments that: (a.) facilitate improvement in billing operational areas; (b.) enhance infrastructure of the billing & reimbursement compliance program; or (c.) improve the quality of services provided by the Institutional Compliance Office.

  
Education, Training and Outreach

  • Independently and in collaboration with other members of the Billing & Reimbursement Compliance section or Institutional Compliance Office, develops and provides education and training on Billing & Reimbursement Compliance Requirements to the MD Anderson workforce, either as part of a corrective and preventive action plan, specialized education or routine education or training activities of the Billing & Reimbursement Compliance program.

QUALIFICATIONS


Education

Required: Bachelor's degree.

Preferred: Master's degree.


Experience

Six years of experience in research or research compliance, general/legal regulatory compliance, corporate compliance, privacy compliance, billing and reimbursement or billing compliance, healthcare administration and/or general business as an analyst, auditor or fraud investigator.

With preferred degree, four years of experience required.

May substitute required degree with additional years of related experience on a one to one basis.





It is the policy of The University of Texas MD Anderson Cancer Center to provide equal employment opportunity without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, disability, protected veteran status, genetic information, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. http://www.mdanderson.org/about-us/legal-and-policy/legal-statements/eeo-affirmative-action.html

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