Senior Compliance Coding Analyst (Medical Center) 5/18/2017
JOB DESCRIPTIONAPPLY Job Summary
The Senior Compliance Coding Analyst is responsible for planning, coordinating and executing complex compliance reviews of billing and documentation activities for The Houston Methodist Specialty Physician Group (HM-SPG) departments. The Senior Compliance Coding Analyst reports to the Director Business Practices. The incumbent works under the general supervision of the Manager, Business Practices and follows departmental policies and procedures as well as basic instructions in carrying out daily tasks. The incumbent will serve as a liaison between HM-SPG Business Practices Office, HM-SPG Departments and community providers and provide direction and guidance to Compliance Coding Analysts.
PATIENT AGE GROUP SERVED
Select the applicable age group(s) of primary customers/patients served by this position.
Neonate (Birth to 28 days)
Infants/Toddlers (29 days to 18 months)
Toddler (18 months to 3 years)
Preschooler (3-6 years)
School Age (6-12 years)
Adolescence (12-18 years)
Young Adult (19-40 Years)
Middle Adult (40-65 Years)
Mature Adult (65 years and older)
System and department specific ICARE values
INTEGRITY: We are honest and ethical in all we say and do.
COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
ACCOUNTABILITY: We hold ourselves accountable for all our actions.
RESPECT: We treat every individual as a person of worth, dignity, and value.
EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.
Duties and Responsibilities are cross-referenced to the hospital s Pillars of Excellence and will be transferred to the Performance Evaluation
1. Manage HM-SPG and community special billing compliance projects that require research, data collection, analysis of processes and evaluation of applicable regulations and guidelines. Act as team lead for risk-based and individual baseline provider reviews. Provide quality assurance, direction and guidance to Compliance Coding Analysts.
2. Lead development, promotion, and maintenance of assigned components of the HM-SPG Business Practices Billing and Compliance Program. Determine the effectiveness and efficiency of billing compliance functions for departments.
3. Provide business practices billing compliance departmental management with periodic status reports, at least monthly, of progress against the annual monitoring and assessment plan and other goals such as cycle time targets
4. Write policies, protocols and procedures to address billing compliance and documentation issues; including drafting and working with others to edit and to adopt.
5. Provide guidance to other Business Practices Office staff to ensure consistency in communication and practice and to foster professional development. Assist department and/or Physician Billing Services in communicating physician billing compliance issues.
1. Track and coordinate physician review process to ensure subsequent reviews are completed in a timely manner, evaluate corrective action and communicate any necessary refunds in a timely manner.
2. Generally demonstrates intermediate industry, billing compliance knowledge, skills and abilities in the review of E/M and procedural coding assessment, auditing, reporting and follow-up processes; capable of handling moderately complex healthcare review projects with minimal supervision.
1. Analyze data/reports from compliance monitoring activities to identify trends, issues, and risk areas. Identify opportunities for improvement and develop formal monitoring recommendations that are value-added and cost-effective.
1. Demonstrates the components of the ICARE values Statement
2. Demonstrates SERVICE PRIDE standards.
1. Design, deliver, and assess educational materials for use in physician/staff training modalities. Coordinate monthly revenue cycle meetings.
2. Serve in the capacity of the MD Audit Team Lead. Coordinate department and PBS MD Audit training sessions.
3. Maintain competency through networking with other compliance leaders outside of the organization and through continuing education. Active member of professional organizations
This position description is not intended to be all inclusive, and the employee will also perform other reasonably related business duties as assigned by the immediate supervisor and other management as required. The Houston Methodist Hospital reserves the right to revise or change job duties and responsibilities as the need arises.
High School diploma/GED. Bachelor s degree preferred.
Minimum 5 years healthcare auditing experience with 3 years in an academic setting.
CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED
Please list below the required and optional Licenses, Certifications and Registrations. If multiple licenses/certs/registrations are available specify the preferred license/cert for the job.
Required Licenses: CPC, CPC-H, CPC-I or CCS (P) certification required Dual certification preferred.
SPECIAL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
1) Demonstrated project management skills proven ability to work under pressure and multi-task competing priorities within established time constraints.
2) Proficient in spreadsheet, word-processing, presentation, and compliance tracking software, as well as Internet Healthcare regulatory websites. Knowledge of healthcare billing and PATH guidelines.
3) Demonstrates effective verbal and written communication skills. Proven presentation skills to a variety of audiences.
4) Demonstrates a positive, helpful and supportive attitude and demeanor.
5) Professional handling of exposure to confidential/sensitive information requires strict confidentiality with no compromise, as well as honesty and integrity.
6) Proven ability to analyze information and situations and to identify issues. Must be able to deal with difficult issues, maintain objectivity, use good judgment, and envision outcomes when making decisions.
7) Performs at a level requiring minimal direct supervision.
Activity Checklist attached (see below)
Normal office conditions and environment, some local travel required to Methodist Hospital locations, occasionally required to work more than 40 hours per week.
Equal Employment Opportunity
Houston Methodist is an Equal Opportunity Employer.
Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law.
VEVRAA Federal Contractor priority referral Protected Veterans requested.
Since its founding in 1919, Houston Methodist Hospital has earned worldwide recognition. Houston Methodist Hospital is affiliated with the Weill Medical College of Cornell University and New York-Presbyterian Hospital, one of the nation's leading centers for medical education and research. Houston Methodist is consistently ranked in U.S. News & World Report s Best Hospital list and was recently named the number one hospital in Texas. FORTUNE magazine has placed Houston Methodist on its annual list of 100 Best Companies To Work For since 2006. Houston Methodist Hospital directs millions of research dollars into patient care and offers the latest innovations in medical, surgical and diagnostic techniques. With 1,119 licensed beds, 67 operating rooms and over 6,000 employees,