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UW Medicine Compliance Department has an outstanding opportunity for a Professional Billing Compliance Analyst.
The individual in this position is responsible for conducting risk-based, high-priority and/or complex compliance reviews and investigations in response to audit and risk assessment activities and government audits/requests. The goal of these reviews and investigations is to ensure accuracy in professional fee billing and compliance with Federal, State, payer and institutional requirements. Captures and analyzes data used to detect trends that may indicate systemic risks to the organization requiring further review, assessment, root cause analysis, or follow-up. Closely collaborates and communicates with physicians and staff on technical billing and coding issues related to audits and risk assessments.
Assess optimal use of clinical applications to ensure compliant professional fee billing and coding. Review EHR templates for teaching physician attestations and documentation of professional fee services to ensure compliant use of the EHR and prevent documentation cloning, over documenting, and other risks related to EHR misuse. Serve as subject matter expert regarding the EHR and help to ensure efficient and compliant problem resolution and education while integrating technical and compliance information. Apply knowledge of Epic and Cerner technical infrastructures and their integration with other clinical applications in a professional coding environment.
Conduct EHR reviews based on risk assessment activities, external or government audits, or in response to an identified potential concern; assess data and formulate recommendations to mitigate or resolve identified issues. Perform follow-up reviews to determine the status of corrective action, efficacy of coding and documentation education, as well as compliance with regulatory guidelines and internal policies. Determine EHR education needs based on compliance audits and provider/staff feedback and prepare training materials.
Collaborate with UWP Compliance and Coding and Charge Capture team members to develop core content, consistent guidelines and an approach to addressing emerging challenges and strategic initiatives related to EHR Integrity. Assist with educational in-services for physicians, other practitioners and clinical staff relating to documentation compliance and new policies and procedures related to billing.
Develop and implement compliance strategies for technical challenges and follow through with implementation of compliance-related technical projects.
Coordinate with Compliance Leadership Team on interpretations and analyses of compliance regulations related to coding projects. Foster collaborative relationship with physicians and clinical departments to effectively communicate coding guidelines and requirements and provide EHR Integrity guidance.
Collect, analyze, summarize and report on EHR integrity related data.
Bachelor’s degree in Business, Healthcare Administration, or related.
Minimum of 4 years of experience in health care compliance or related field with 1 year of project based experience. Significant experience working with current CPT-4 and ICD-9/10 rules and clinical documentation requirements.
Certification as CPC, RHIT, RHIA, or CCS-P required. ICD-10 certification required.
Equivalent education/experience will substitute for all minimum qualifications except where there are legal requirements such as license/certification/registration.
CPMA, CHCA or equivalent; Experience in an academic healthcare environment.
CONDITIONS OF EMPLOYMENT The application process for UW positions may include completion of a variety of online assessments to obtain additional information that will be used in the evaluation process. These assessments may include Work Authorization, Cover Letter and/or others. Any assessments that you need to complete will appear on your screen as soon as you select “Apply to this position”. Once you begin an assessment, it must be completed at that time; if you do not complete the assessment you will be prompted to do so the next time you access your “My Jobs” page. If you select to take it later, it will appear on your "My Jobs" page to take when you are ready. Please note that your application will not be reviewed, and you will not be considered for this position until all required assessments have been completed.
Founded in 1861, the University of Washington is one of the oldest public institutions in the west coast and one of the preeminent research universities in the world. The University of Washington is a multi-campus university comprised of three different campuses: Seattle, Tacoma, and Bothell. The Seattle campus is made up of sixteen schools and colleges that serve students ranging from an undergraduate level to a doctoral level. The university is home to world-class libraries, arts, music, drama, and sports, as well as the highest quality medical care in Washington State and a world-class academic medical center. The teaching and research of the University’s many professional schools provide undergraduate and graduate students the education necessary toward achieving an excellence that will serve the state, the region, and the nation. As part of a large and diverse community, the University of Washington serves more students than any other institution in the Northwest.