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The School of Medicine has an outstanding opportunity for a 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 which can include reported billing compliance questions and concerns and government or other external audit requests. The goal of these reviews and investigations is to ensure accuracy in billing and compliance with Federal, State, payer, and institutional requirements. The Compliance Analyst also 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; acts as an advisor to Compliance leadership on matters related to technical billing and coding of health care services; focuses on increasing quality standards for consistency and accuracy of compliance documentation and coding issues, documentation of audit findings, adoption of new audit criteria, and audit scheduling and workflow efficiency.
•Perform complex coding and documentation compliance reviews across a variety of specialties using applicable rules, regulations, and coding conventions for billing to determine the accuracy of coded and billed services, including teaching physician documentation requirements. Obtain, organize, and format billing and other data captured through the review process. Report and review audit findings with supervisor, manager, and/or director on a regular basis to identify trends, issues, and potential risk areas. Inform management of issues or concerns identified with coding practices of faculty or coding staff. Prepare clear, concise written reports related to the review findings for internal and external reporting purposes. •Conduct high-priority and/ or complex reviews or investigations identified through risk assessment activities which could include external or government audits or responses to an inquiry or identified potential concern. Assess data and formulate recommendations to mitigate or resolve any identified issues. Determine the status of implemented recommendations, including any follow-up audits. •Identify refunds or adjustments, extrapolate refunds when required. •Coordinate projects conducted by contracted external vendors and answer questions regarding the compliance review process. Review data and reports drafted by external vendors. •Serve as a knowledge resource for coding and documentation standards; serve as an advisor to the Compliance Department on matters related to technical billing and coding of health care services. Respond to billing and coding questions related to review findings from practitioners and staff. •Establish and maintain effective and collaborative relationships with physicians, administrative and revenue support staff, and UW Medicine and CUMG compliance staff. Maintain awareness of health care billing processes implemented in the organization. Assist with process improvement projects that address audit quality or efficiency. •Assist with training of new employees and development of coding competencies and quality threshold standards for advancement from probationary period and as input into performance evaluation process. •Participate in department process improvement activities, including development of department operational policies and procedures.
MINIMUM REQUIREMENTS •Bachelor’s Degree and four to five 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.
Equivalent education and/or experience may substitute for minimum requirements.
DESIRED REQUIREMENTS •Clinical degree/certification and/or at least 4 years of experience in a compliance, coding and/or medical billing environment may be considered in lieu of degree. •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.