Job Ref: 23699
Talent Area: Professional
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
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.
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.
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)
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.
Duties and Responsibilities are cross-referenced to the hospitals Pillars of Excellence and will be transferred to the Performance Evaluation
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.
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.
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.
1. Demonstrates the components of the ICARE values Statement
2. Demonstrates SERVICE PRIDE standards.
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.
Bachelor’s degree in business, hospital/healthcare administration preferred; Bachelor of Science in Nursing or a related field preferred.
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.
Activity Checklist attached (see below)
Normal office conditions and environment, some local travel required to Methodist Hospital locations, occasionally required to work more than 40 hours per week.
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.