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JOB DETAILS

Senior Compliance Coding Analyst

Job Ref: 23699

Talent Area: Professional

Location:
Houston Methodist Specialty Physician Group
Houston, TX 77030

Area/Department: Business Practices

Employment Type: Regular

Job Type: Full-Time

Organization: Houston Methodist

Work Shift: DAY

Work Week: M - F


Company Profile

Since its founding in 1919, Houston Methodist has earned worldwide recognition. Houston Methodist is affiliated with the Weill Medical College of Cornell University and New York-Presbyterian Hospital, one of the nation's leading centers for medical education and research. Houston Methodist is consistently ranked in U.S. News & World Report’s “Best Hospital” list and was recently named the number one hospital in Texas. FORTUNE magazine has placed Houston Methodist on its annual list of “100 Best Companies To Work For” since 2006.  Houston Methodist directs millions of research dollars into patient care and offers the latest innovations in medical, surgical and diagnostic techniques. With 1,119 licensed beds, 73 operating rooms and over 5,000 employees, Houston Methodist offers complete care for patients from around the world.


Job Summary


POSITION SUMMARY

Under the direction of the Manager for Billing Compliance, the Sr. Compliance Coding Analyst is responsible for various duties in support of accurate billing and coding compliance with Medicare and third party payment rules and internal policies. 


PATIENT AGE GROUP SERVED
Select the applicable age group(s) of primary customers/patients served by this position.


 Not applicable
 Neonate (Birth to 28 days)
 Infants/Toddlers (29 days to 18 months)
 Toddler (18 months to 3 years)
 Preschooler (3-6 years)
 School Age (6-12 years)
 Adolescence (12-18 years)
 Young Adult (19-40 Years)
 Middle Adult (40-65 Years)
 Mature Adult (65 years and older)


ICARE VALUES
System and department specific ICARE values

INTEGRITY: We are honest and ethical in all we say and do.
COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
ACCOUNTABILITY: We hold ourselves accountable for all our actions.
RESPECT: We treat every individual as a person of worth, dignity, and value.
EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.

JOB RESPONSIBILITIES

Duties and Responsibilities are cross-referenced to the hospitals Pillars of Excellence and will be transferred to the Performance Evaluation

PEOPLE
1. Manage HM-SPG and community special billing compliance projects that require research, data collection, analysis of processes and evaluation of applicable regulations and guidelines.  Act as team lead for risk-based and individual baseline provider reviews. Provide quality assurance, direction and guidance to Compliance Coding Analysts.
2. Lead development, promotion, and maintenance of assigned components of the HM-SPG Business Practices Billing and Compliance Program. Determine the effectiveness and efficiency of billing compliance functions for departments.
3. Provide business practices billing compliance departmental management with periodic status reports, at least monthly, of progress against the annual monitoring and assessment plan and other goals such as cycle time targets
4. Write policies, protocols and procedures to address billing compliance and documentation issues; including drafting and working with others to edit and to adopt.
5. Provide guidance to other Business Practices Office staff to ensure consistency in communication and practice and to foster professional development. Assist department and/or Physician Billing Services in communicating physician billing compliance issues.

FINANCE
1. Track and coordinate physician review process to ensure subsequent reviews are completed in a timely manner, evaluate corrective action and communicate any necessary refunds in a timely manner.
2. Generally demonstrates intermediate industry, billing compliance knowledge, skills and abilities in the review of E/M and procedural coding assessment, auditing, reporting and follow-up processes; capable of handling moderately complex healthcare review  projects with minimal supervision.


QUALITY/SAFETY
1. Analyze data/reports from compliance monitoring activities to identify trends, issues, and risk areas. Identify opportunities for improvement and develop formal monitoring recommendations that are value-added and cost-effective.


SERVICE
1. Demonstrates the components of the ICARE values Statement
2. Demonstrates SERVICE PRIDE standards.



GROWTH/INNOVATION
1. Design, deliver, and assess educational materials for use in physician/staff training modalities. Coordinate monthly revenue cycle meetings.
2. Serve in the capacity of the MD Audit Team Lead. Coordinate department and PBS MD Audit training sessions.
3. Maintain competency through networking with other compliance leaders outside of the organization and through continuing education.  Active member of professional organizations


This position description is not intended to be all inclusive, and the employee will also perform other reasonably related business duties as assigned by the immediate supervisor and other management as required. The Houston Methodist Hospital reserves the right to revise or change job duties and responsibilities as the need arises.

EDUCATION REQUIREMENTS

Bachelor’s degree in business, hospital/healthcare administration preferred; Bachelor of Science in Nursing or a related field preferred. 

EXPERIENCE REQUIREMENTS
Minimum 4 years relevant experience in billing compliance. Teaching physician experience preferred.


CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED
Please list below the required and optional Licenses, Certifications and Registrations.  If multiple licenses/certs/registrations are available specify the preferred license/cert for the job.

Required Licenses: Minimum of one professional coding certification (CCS-P, CPC, RHIA, RHIT or CHRC) 

SPECIAL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED

Please add additional knowledge, skills and abilities required to perform the essential functions.

·         Working knowledge of clinical research billing, third party billing regulations with emphasis on CMS/Medicare rules.

·         Strong analytical and interpersonal skills.

·         Effective decision-making and team-building skills.

·         Demonstrates effective oral and written communication skills, including the ability to maintain positive rapport with personnel at all levels and in all situations.

·         Ability to work under pressure and balance many competing priorities.

·         Ability to work with difficult people and in difficult situations.

·         Ability to adapt to a rapidly changing environment and to adjust to new requirements.

·         Applies sound judgment in applying and interpreting policies, procedures, laws, rules, and regulations applying to compliance and monitoring.

  • 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.


PHYSICAL REQUIREMENTS
Activity Checklist attached (see below)

WORKING ENVIRONMENT

Normal office conditions and environment, some local travel required to Methodist Hospital locations, occasionally required to work more than 40 hours per week.


Equal Employment Opportunity

Houston Methodist is an Equal Opportunity Employer.

Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of  race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law.

VEVRAA Federal Contractor – priority referral Protected Veterans requested.