Billing Compliance Analyst

Job Summary

Serves as a resource to the NCHS Billing Compliance Program and is responsible for monitoring Billing Compliance activities to ensure compliance with federal, state and local regulations, and NCHS policies.

Job Specific Duties

• Analyzes Billing Compliance review outcomes and proactively identifies trends and high-risk areas.
• Develops Billing Compliance audit activity and trends reports.
• Develops appropriate recommendations for Corrective and Preventative Action (CAPAs).
• Utilizes innovative ideas and tools to enhance the operational effectiveness.
• Monitors, analyzes, and reports the effectiveness of Billing Compliance risk-based training.
• Presents findings and feedback in a helpful manner to appropriate parties and provides pertinent education and/or guidance to improve billing/coding procedures.
• Documents education provided to applicable parties and maintains records of training sessions in the case management system as part of the Corrective and Preventative Actions (CAPAs).
• Researches changes in national and local coding and billing coverage decisions: maintain current knowledge of appropriate billing procedures.
• Performs follow-up audits to ensure complete and appropriate CAPAs.
• Supports the review and analysis of Recovery Audit Contractors (RAC) requests and other external requests for recoupment.
• Works collaboratively with NCHS members to identify and recommend strategies for process improvement.

Minimum Job Requirements

• Bachelor's Degree
• Certified Coder CPC, CCS, RHIA, or RHIT
• 4-7 years of experience related to billing compliance, patient financial services, revenue cycle, HIM services, health care data analyst, or other relevant experience
• Experience with federal auditing regulations, including billing, coding and documentation requirements
• Experience conducting data mining audits

Knowledge, Skills, and Abilities

• Experience with CERNER is preferred.
• Experience in conducting Hospital, Professional Fee Service, and Research billing and coding audits preferred.
• Demonstrated experience working as part of an interdisciplinary team.
• Able to work independently.
• Able to research, abstract and communicate federal, state and payer documentation, billing and coding rules and regulations.
• Ability to be flexible, multitask, and switch priorities as well as work comfortably in a deadline driven/productivity environment.
• Ability to prioritize, organize, plan, and implement services as well as handle multiple projects/problems simultaneously.
• Excellent written and verbal communication skills.
• Excellent time management and organization skills.
• Strong interpersonal, collaboration, and presentation skills.
• Able to use tact, diplomacy, discretion, and judgment.
• Able to maintain confidentiality of sensitive information.