Compliance Analyst II

Rochester, NY

GENERAL PURPOSE:

Oversees and supports a portfolio of clinical specialties as assigned by Director of Compliance through review, analysis, communication and training activities. Determines compliance with billing policies and procedures including government regulatory requirements to ensure applicable laws are followed. Develops and disseminates comprehensive resources, education and training programs to support compliance and operational policies and procedures.

SPECIFIC RESPONSIBILITIES:

  • AHIMA certification as Registered Health Information Technician (RHIT) or AAPC Certification as a Certified Professional Coder (CPC), Certified Professional Biller (CPB) or Certified Professional Medical Auditor (CPMA), Certified Outpatient Coder (COC), or Certified Professional Compliance Officer and/or CHC Certification in Healthcare Compliance (CHC) or as a Certified Compliance and Ethics Professional or equivalent professional certification preferred.

  • Analyzes data to identify potential risk areas. Performs internal reviews and audits of professional and facility billing to determine compliance with applicable policies and procedures. Conducts in-depth reviews of medical record chart documentation to ensure compliance with CMS Guidelines. Ensures chart documentation supports the selected billing code and level.

  • Prepares and submits reports containing review findings. Identifies areas requiring change. Makes recommendations for corrective action and is accountable for appropriate follow-up. Assists in formulating, reviewing, and updating Medical Center Compliance policies.

  • Responds to individual/departmental concerns by conducting appropriate follow-up: records initial inquiries and assesses appropriate course of action; conducts investigative work to assess the situation; formulates proposed resolutions and discusses with necessary parties to determine corrective actions; consults with the Director of Compliance Audit.

  • Creates and provides presentations to educate and train faculty, residents and staff on reimbursement, fraud and abuse and other healthcare related compliance issues and Medicare and Medicaid requirements. Acts as a resource on billing, coding and complex reimbursement issues to Medical Center personnel on a daily basis.

  • Assists in due diligence activities related to physician practice and provider acquisitions as directed by the Director of Compliance and/or Office of Counsel. Generates timely, concise, and coherent due diligence reports.

  • Participates in special projects and investigations as directed by the Chief Compliance Officer, Director of Compliance, and/or Office of Counsel. Assists in responding to external audits, government investigations, and litigation.

  • Maintains current knowledge of issues in the area of professional compliance issues through networking with counterparts at other teaching hospitals, review of literature, and participation in seminars and update programs.

Other duties as assigned

REQUIREMENTS:

  • Bachelor’s degree in related field required;

  • 3-5 years of relevant experience required;

  • or an equivalent combination of education and compliance/coding/consulting experience required.

  • 5 years’ experience in a direct or indirect healthcare compliance or privacy role in an integrated health system or a component of such preferred.

  • Prior compliance program experience in an Academic Medical Center or other complex setting preferred.

  • Strong communication, interpersonal, and public speaking skills required;

  • Ability to efficiently produce clear, concise, and complete written audit reports required.

  • Excellent analytical, organizational, and problem-solving skills required.

  • Ability to lead and manage complex projects and effectively manage staff in a motivational and positive manner.

  • Willingness to collaborate with others and to work as part of a team required.

  • Ability to maintain high discretion and confidentiality with sensitive information required.

  • Experience creating, editing, and manipulating data and documents using Microsoft Office preferred.

  • Ability to effectively use privacy and compliance monitoring and documentation systems preferred.

  • Prior experience with project management preferred.

  • Prior experience with APG, APC, and/or DRG coding methodologies preferred.

  • Prior experience with professional billing in specialty areas preferred.

  • AHIMA certification as Registered Health Information Technician (RHIT) or AAPC Certification as a Certified Professional Coder (CPC), Certified Professional Biller (CPB) or Certified Professional Medical Auditor (CPMA), Certified Outpatient Coder (COC), or Certified Professional Compliance Officer and/or CHC Certification in Healthcare Compliance (CHC) or as a Certified Compliance and Ethics Professional or equivalent professional certification preferred.

The University of Rochester is committed to fostering, cultivating, and preserving a culture of equity, diversity, and inclusion to advance the University’s mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion/creed, sex, sexual orientation, citizenship status, or any other status protected by law. This commitment extends to the administration of our policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and persons with disabilities consistent with these values and government contractor Affirmative Action obligations.

How To Apply

All applicants must apply online.

EOE Minorities/Females/Protected Veterans/Disabled

Pay Range

Pay Range: $62,525 - $93,766 Annually

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job’s compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.

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Location: Health Sciences
Full/Part Time: Full-Time
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