BILLING COMPLIANCE ANALYST
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POST DATE 8/16/2016
END DATE 10/18/2016
University of Kansas Hospital
JOB DESCRIPTIONJob Details
I am at least 18 years of age
I am authorized to work in the United States
I meet the job requirements as described
Work among the best. We are a top 25 employer in the metro area offering a wide array of career opportunities within our organization. We have a leading reputation for patient care, medical education, research, and community service. We value and respect the talented, committed, and diverse people who make up our hospital; they are our most important strength. The hospital offers very competitive wages and an outstanding benefit package.
We currently have an opening for Billing Compliance Analyst
* Effectively uses the appropriate financial concepts and tools to analyze situations and make financial decisions that support the achievement of short and longer-term departmental objectives.
* Complies with Medicare/Medicaid rules and regulations.
* Assists Director, Manager, and Coordinator of Billing Compliance in organizing and implementing compliance initiatives related to Hospital billing in accordance with rules, regulations, laws and payer contractual requirements.
* Functions as the primary resource for clinical departments requesting addition of new charge codes for hospital services, identifies and researches associated compliance risks, and makes recommendations to the Chargemaster Coordinator / Manager of Billing Compliance regarding exceptional requests (including investigational and high cost items).
* Researches coding, coverage, medical necessity and other compliance issues for all payers related to new charges added to the charge master.
* Educates clinical departments on the Charge Master maintenance process, assists with completion of requisite forms, assigns General Ledger and Insurance codes, transmits approved CDM maintenance forms to HIS for input into SMS and O2, and communicates completion of process back to clinical departments.
* Assumes primary responsibility for insuring that all necessary ongoing maintenance to the Charge Description Master is completed in response to annual coding updates and periodic Medicare bulletins, newsletters and revisions to National and Local Medical Review Policies.
* Serves as primary resource to Patient Financial Services staff for reporting problems and denials on individual claims. Researches coding issues and recommends solution to account representative. Identifies source of problem and implements corrective action to insure that Charge Master is updated to prevent future rejections/denials and to insure accurate and expedient reimbursement.
* Completes routine claim audits and transaction testing to insure regulatory billing compliance and to support departmental compliance initiatives.
* Assists with the review and response to external governmental audits, including those from our Medicare Administrative Contractor, Recovery Audit Contractor, Medicaid Integrity Program, and the Office of Inspector General.
* Prepares and monitors reports intented to prevent and correct charge capture and coding compliance issues.
* Serves as liaison between Finance and Charge Audit Nurse (Internal Audit) to inform of changes in Charge Master and charging protocol in clinical departments.
* Serves on compliance committees as requested by Director.
* Monitors WPS and CMS for updates to Local and National Coverage Determination Policies. Coordinates comment letters for draft policies. Communicates changes to policies to the relevant clinical and financial personnel.
* Performs reviews and appeals of claims with Medical Necessity edits.
* Facilitates the maintenance of medical necessity edits and pathways in Healthworks and O2 order entry pathways.
* Demonstrates knowledge of the mainframe systems, O2 and SMS pathways, Excel and Word.
* Maintains a high level of involvement in the day to day activities related to areas of responsibility. Provides leadership presence and guidance through direction and role modeling.
* Maintains an Open Issues Log and reviews with Director of Billing Compliance at regularly scheduled meetings to secure needed assistance in resolving issues and to promote accountability.
* Immediately reports compliance issues to the responsible Manager and Director of Billing Compliance and assists with the development of a corrective action plan.
* Attends and actively participates in training and education to increase knowledge and professional growth within this position.
* High School Diploma or equivalent required
* Bachelor's Degree in Business or Nursing required
* Technical/Professional Training/Degree in Business, Med Records Coding, Nursing or ITS preferred
* Minimum of three years experience in Hospital Billing, Medical Records or Charge Audit environment.
* Eight years of relevant experience will be considered in lieu of the Bachelor Degree requirement.
* Demonstrated PC skills.
* Demonstrated knowledge of Hospital Charging procedures and protocol.
* Demonstrated general knowledge of billing and coding rules and regulations for governmental and managed care payers.
* Experience with coding and Charge Description Master maintenance is desirable. Excellent analytical, critical thinking, and problem solving skills.
* Ability to communicate clearly and use good judgement. Ability to work in a multi-focused environment. Ability to maintain patient and compliance information in strict confidence.
*** If selected to move forward in the hiring process, you will receive an email invitation to schedule your interview for this position. Please continue to check your email after you have submitted your complete application online.
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The University of Kansas Medical Center is committed to providing an equal opportunity for all qualified individuals to be considered for employment, benefits and conditions of employment, and to participate in or benefit from education programs and activities, regardless of race, religion, color, ethnicity, sex, disability, national origin, ancestry, age, status as a veteran, sexual orientation, marital status, parental status, gender identity, gender expression, or genetic information. A university community that provides equal opportunity for all will make significant strides towards the elimination of discrimination.
It is the mission of the Equal Opportunity Office to create a community of equality and inclusiveness that provides full and fair opportunities for all persons and to foster an intellectually and culturally diverse environment of learning and leadership where all individuals are valued, respected, and unhindered in their pursuit of excellence in their work and education.