This role leads Professional Billing Compliance to support University Clinical Health compliance with all state and federal laws governing reimbursement for health care services. The role develops and maintains policies governing the billing practices of UCH, supports and monitors the effectiveness of Billing Compliance training and education, identifies and evaluates areas of risk and responds to potential violations of regulations or policies. The incumbent integrates compliance activities with physician leadership and works closely with UT Department Chairs and Division Heads, Directors of Operations, Revenue services functions and UCH clinic staff.
The incumbent tracks changes in billing compliance regulation and develops processes and programs to minimize billing compliance risk.
KEY RESULT AREAS (KRAs)
Track changes in PB regulations developments
Develop and maintain billing compliance policy
Develop risk assessment methodology
Develop and implement PB work plan.
Report on investigations related to PB compliance.
Develops and implements billing compliance learning resources.
Audit against contractual requirements and targeted risk areas.
Implement remedial action plans
Analysis of coding and billing trends
Implement programs to report billing practices concerns
Bachelor’s degree and at least 7 years of directly related experience.
Ability to supervise and train employees, to include organizing, prioritizing and scheduling work assignments.
Strong interpersonal skills and the ability to communicate effectively, both orally and in writing.
Coding and/or medical record certification(s) preferred.
Healthcare Compliance Certification preferred.
Skilled in developing policies and procedures related to professional billing compliance.
Ability to develop and conduct compliance training programs.
Extensive knowledge of federal and state laws and regulations regarding Medicare and Medicaid and the ability to interpret, adapt and apply CMS guidelines and procedures.
Knowledge of statistical sampling and survey methodology and ability to gather and analyze medical records and billing data and generate reports.
Knowledge of computerized information systems used in compliance applications.