Compliance Analyst I - Rochester, United States - University of Rochester

Description

Compliance Analyst I - Remote Hybrid Opportunity

Job ID251882
Location
Strong Memorial Hospital
Full/Part TimeFull-Time
Regular/TemporaryRegular

Full Time 40 hours Range URG 107 Patient Financial Services

Responsibilities
Position Summary:

This position oversees outpatient Medicare, Medicaid and third-party payor audits, and directs all responses to assure audits are responded to timely and appropriately. Coordinates activities of all outpatient billing areas in relation to audits through interaction with the Director, Managers and Supervisors within the Patient Financial Services office to assure timely responses and minimize legal and financial risk to the organization. Acts as the primary contact/coordinator for all internal and external sources regarding routine audits, including Medicare and Medicaid credit balance quarterly audits, audits obtained from the Office of Medicaid Inspector General, and the Attorney General's Office. Maintains a comprehensive listing of all audits and compliance projects including resolutions. Coordinates resolution and documentation of all compliance projects to assure all parties are refunded as appropriate and that all necessary documentation is compiled and retained.

Supervision and Direction Exercised:

Responsible for monitoring own performance on assigned tasks against procedure standards.

Assists Manager in preparing compliance reports. Assumes functions of manager in his/her absence.

Machines and Equipment Used:

Standard office equipment, including but not limited to desktop computer, Flowcast billing system for both Hospital and Medical Faculty Group, Microsoft Office, Excel, Word and Email, telephone, photocopy machine, 10 key adding machine, fax.

Typical Duties:

Under general direction and with latitude for independent judgment:

35% In a highly independent environment, provides direction, oversight and resolution to outstanding audits and compliance projects for the outpatient department within Patient Financial Services. Receives, documents, tracks and compiles responses to Medicare, Medicaid and third party payor audits within the guidelines provided by the governmental, legal agency/authority, and/or third party payors. Coordinates and evaluates the activities of all outpatient billings areas within the Patient Financial Services Office to assure timely resolution, gain insight on auditing trends for review by compliance, and propose improvements to internal processes. Additionally, responsible for the documentation and maintenance of all current outpatient audit workflows as it relates to these audits and projects.

20% Serves as a focal point for coordinating the total resolution of compliance projects to assure all payors are refunded appropriately, up to and including follow-up with billing supervisors and payor representatives. Identifies activities that prevent resolution and works with the Billing Manager to resolve. Provides recommendations to the Billing Manager to refine billing processes and assist in creating resource tools for internal billing staff.

15% Acts as the liaison between the Patient Financial Services Office and the Compliance Department to address audits and coordinate resources necessary to respond to all audits. Submits reports and related documentation to all levels of managements and department administrators to support billing compliance and superior customer service. Under the direction of the PFS Director, provides a quarterly reporting of all major audits to Senior Management.

15% Performs targeted account audits and provides reports to PFS management and the Compliance Department based on prior compliance issues both to assure full resolution of previous concerns and to evaluate current processes/workflows.

10% Acts as a liaison to all outpatient hospital departments to coordinate compliance issues as far as charging and related refunding. Works to identify, document and report to PFS management the root cause of issues and the system and/or workflow improvements being made to avoid these errors in the future.

3% Attends internal and external meetings and seminars when appropriate; attends continuing education seminars as needed to stay current with internal billing systems, the outpatient billing process, changes in payer requirements and current audit trends.

2% Other duties as assigned - based on knowledge base and/or the necessity to create a well defined and documented process

Expectations:

Participate in department /team staff meetings education classes and training:

Attend monthly department and team staff meetings
Stay current on HIPAA guidelines through education and reading monthly emails
Participate in educational training such as Strong Commitment I care and annual In Service
Join PFS committees such as planning PFS events or addressing employee issues
Cross train on PFS processes to enable assistance and fill in as needed

Requirements:

Associates Degree in Business, Health Care Administration
or related discipline and 2 years of relevant health care experience
or an equivalent combination of education and experience
Bachelor's degree preferred
Ability to demonstrates good working knowledge of billing systems, Medicare, Medicaid and third-party payor billing regulations.

This document describes typical duties and responsibilities and is not intended to limit management from assigning other work as required.

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.

EOE Minorities/Females/Protected Veterans/Disabled

Pay Range
Pay Range: $ $31.63 Hourly

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.