Senior Compliance Coding Analyst - Business Practices (Medical Center)

At Houston Methodist, the Sr Compliance Coding Analyst position is responsible for supporting accurate billing and coding compliance with Medicare and third-party payments and internal policies. Responsibilities for this position include serving as subject matter expert, performing complex and high risk-based and baseline compliance reviews, and identifying potential risk areas and revenue potential. The Sr Compliance Coding Analyst position partners with stakeholders to provide feedback regarding documentation and billing practices to identify potential risk and identify and capture potential revenue opportunities. This position performs quality assurance, detailed claims analysis, and medical record reviews of complex claims and records and serves as a mentor to more junior team members, assisting with onboarding and training as needed.

Requirements:

PEOPLE ESSENTIAL FUNCTIONS

• Collaborates with revenue integrity teams to review provider services and provide effective education and feedback. Coordinates revenue cycle physician feedback meetings and other meetings as needed.

• Effectively and proactively communicates with all stakeholders to resolve issues and discrepancies in a timely manner.

• Actively participates in meeting and huddles using positive communication and makes positive contributions that contribute to department success. Mentors more junior team members and supports the training and onboarding of new staff.

SERVICE ESSENTIAL FUNCTIONS

• Conducts risk-based and baseline reviews of complex and escalated claims or records in a timely manner, evaluates corrective actions and processes applicable refunds within established timeframes of communication to provider and/or department.

• Coordinates with appropriate stakeholders to provide feedback regarding documentation and billing practices as well as potential risk areas with electronic medical record.

• Provides periodic status reports of risk-based audit outcomes. Provides education as appropriate regarding department specific practices. Serves a subject matter expert.

• Effectively communicates audit results to faculty and staff.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• Performs billing compliance reviews that meet department quality standards.

• Interprets and communicates potential revenue loss associated with incorrect coding or application of coding guidelines.

• Identifies potential risk areas and/or revenue potential through audit process. Communicates information to faculty, staff and residents through newsletters or webinars.

FINANCE ESSENTIAL FUNCTIONS

• Utilizes resources effectively and efficiently, demonstrating responsible financial stewardship. Manages own time effectively and prioritizes work to achieve maximum results in a timely manner.

• Identifies, prioritizes and conducts reviews based on data analytics. Coordinates with appropriate stakeholders to identify and capture potential revenue opportunities.

• Verifies that accurate and concise claims are being billed to patients and third-party payers. Performs quality assurance.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

• Proactively stays up-to-date on compliance coding industry and practices. Shares learnings with team.

• Proactively manages own professional development. Completes My Development Plan.

This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.

Qualifications:

EDUCATION

• Associate's degree or additional two years of experience (in addition to the minimum experience requirements listed below) required in lieu of degree

WORK EXPERIENCE

• Four years of experience in billing compliance

• Experience working in teaching environment preferred

LICENSES AND CERTIFICATIONS - REQUIRED

• N/A

LICENSES AND CERTIFICATIONS - PREFERRED

• CPC - Certified Professional Coder (AAPC) OR
• RHIA - Registered Health Information Administrator (AHIMA) OR
• RHIT - Certified Health Information Technician (AHIMA) OR
• CHRC - Certified in Healthcare Research Compliance (HCCA) OR
• CCS-P - Certified Coding Specialist Physician-based (AHIMA) OR
• CPC-H - Certified Professional Coder - Hospital (AAPC) OR
• CPC-I - Certified Professional Coder Instructor (AAPC)

KNOWLEDGE, SKILLS, AND ABILITIES

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through ongoing skills, competency assessments, and performance evaluations

• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security

• Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles

• Strong analytical and interpersonal skills

• Effective decision-making skills

• Ability to effectively work and communicate across all levels of the organization

• Ability to adapt to a rapidly changing environments and to adjust to new requirements

• Demonstrated sound judgment in applying and interpreting policies, procedures, laws, rules and regulations applying to compliance and monitoring

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

• Uniform No
• Scrubs No
• Business professional Yes
• Other (department approved) No

ON-CALL*
*Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.

• On Call* No

TRAVEL**
**Travel specifications may vary by department**

• May require travel within the Houston Metropolitan area Yes
• May require travel outside Houston Metropolitan area No