About This Role
This compliance analyst position assists with overseeing and advancing the professional fee compliance, billing integrity, and regulatory adherence programs for CUIMC. The role serves as a subject matter expert on complex coding, billing, and reimbursement matters, ensuring adherence to CMS regulations, federal and state laws, and applicable coding guidelines. The position provides advisory guidance for coding audits, documentation reviews, provider education, risk assessments, regulatory monitoring, and corrective action initiatives.
Responsibilities
- Provide oversight and perform ongoing, risk-based, and ad hoc coding auditing of complex services across multiple specialties, rendered by physician and non-physician practitioners using current coding guidelines
- Pay attention to Medicare/Medicaid, medical necessity, and NCD/LCD requirements, including retrospective audits for established providers and prospective audits for newly onboarded providers to ensure appropriate documentation, coding accuracy, and billing compliance
- Manage departmental compliance teams under the leadership of the Senior Director and Chief Compliance Officer
- Collaborate closely with the central revenue office and departmental compliance teams to address revenue and billing integrity needs
- Support departmental compliance teams by providing advisory guidance and expert knowledge of CPT/HCPCS and ICD-10 guidelines across multiple specialties
- Provide teaching facility guidance and professional fee billing, including global surgical package rules, modifier usage, incident-to services, split/shared services, and emerging regulatory changes
- Assist with managing CUIMC
- Assist with CUIMC
- Assist in the development and delivery of educational sessions related to coding, documentation, and payer-specific billing requirements for physicians and billing personnel
- Collaborate with the central revenue office, clinical staff, providers, and administrative personnel to address compliance issues
- Assist with development and management of compliance policies and procedures
- Assist Compliance Leadership with other assignments and related compliance responsibilities as needed
Requirements
- Bachelor
- Current credential of CPC/CCS-P or related coding professional credential
- Expert knowledge of Evaluation and Management (E/M) guidelines and surgical coding in multiple specialties with preference in orthopedics, surgery, and cardiology; and high-working knowledge in more
- Epic electronic health record experience
- Experience in using one or more audit tools (e.g. Audit Manager, MDAudit, etc.)
- Excellent analytical and communication skills, both oral and written, including Microsoft Office advanced proficiency
