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Billing Compliance Analyst

Job Ref: 25983

Talent Area: Professional

Houston Methodist Research Institute
Houston, TX 77030

Area/Department: Research Billing Compliance

Employment Type: Regular

Job Type: Full-Time

Organization: Houston Methodist

Work Shift: DAY

Work Week: M - F

Company Profile

Houston Methodist Research Institute was formed in 2004 to rapidly and efficiently translate discoveries made in the laboratory and the clinic into new diagnostics, therapies and treatments.  The research institute was created to provide the infrastructure and support for these endeavors, and to house the technology and resources needed to make innovative breakthroughs in important areas of human disease.  A 540,000 square foot building dedicated to research, the research institute houses over 1,500 staff and trainees, 277 principal investigators and has more than 840 ongoing clinical trials.

Job Summary

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

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)


I. Provide personalized care and service by consistently demonstrating our I CARE 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. 

II. Focuses on patient/customer safety
III. Delivers personalized service using HM Service Standards
IV. Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)
V. Intentionally rounds with patients/customers to ensure their needs are being met
VI. Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job

Duties and Responsibilities are cross-referenced to Houston Methodist¿s Pillars of Excellence and will be transferred to the Performance Evaluation. Please include estimated % weighting for each Pillar.

PEOPLE ¿ 30%
1. Facilitate interactions among various teams to include Clinical Trial Managers, Office of IRB, Academic Office of Clinical Trials, Grants and Contracts, Internal Audit, Institutional Billing, and Hospital Finance.
2. Collaborate with Principal Investigators, Directors, Managers and Research Nurse/Coordinator of research with processing IDE Device studies to include getting device entered into hospital inventory database (MARS) and appropriate codes and modifiers for each item using Code Correct.
3. Assist in training and educating the Principal Investigators, Coordinators and other personnel on clinical documentation requirements and research billing processes for Device Trials.   

1. Assume primary responsibility for Administrative Review and processing of Investigational Device Studies (IDE) in MORTI.
2. Coordinate all submission activities for Investigational Device Studies including preparing documents for Finance, Legal, Grants and Contracts, and CMS review of IDE protocols.
3. Responsible for completing and processing daily error reports such as records with inaccurate NCT, patients on multiple studies, and updating coordinator information.
4. Process manual daily bill hold accounts and maintain manual bill hold database.

1. Manage files and maintain databases for IDE submissions.
2. Assure accurate, complete, and current records are maintained in accordance with the clinical study protocol and investigation plan.

1. Responsible for ensuring accurate pricing and charges for IDE studies in accordance with Federal/State guidelines.
2. Assist departments with budget development for pricing device items/supplies in CDM.

1. Assist Internal Audit with document preparation for audit findings. 
2. Responsible for cross training with other staff in Research Billing Compliance.
3. Responsible for staying current of FDA Device Regulations and CMS billing guidelines.

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.

High school diploma or GED 

Minimum 5 years relevant experience in research billing and compliance, preferably Investigational Device Trials.

Minimum of one professional coding certification (CCS-P, CPC, RHIA, RHIT or CHRC) within 12 months of hire.

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

¿ 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.
¿ 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.
¿ Maintains a positive and supportive attitude and demeanor.

Activity Checklist attached (see below)

Normal office conditions and environment.  Work hours are regular.  Some travel required to various Methodist Hospital System locations.

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.