Billing & Coding Compliance Analyst & Educator

Job Code: IA1140
Full Time Days

 

ABOUT US

We are welcoming a new era in healthcare where achieving good health is just the beginning. At UVA Health Northern VA & Culpeper, we believe in caring for the whole person by getting to know – and making connections with – our patients. By combining the talent and expertise of our people, the breadth of capabilities across our system, and our commitment to helping our communities get better and stay healthy, we are improving the patient experience.

As a UVA Health Northern VA & Culpeper team member, you will have a voice in patient care decisions, support the most advanced medical technologies and feel a strong sense of satisfaction from making a difference in people’s lives every day.

 

JOB TYPE

Classification: Exempt

Supervises Positions: No

 

JOB SUMMARY

Reporting to the Director of Compliance and Privacy, the Billing & Coding Compliance Analyst & Educator is responsible for working to ensure that UVA Community Health complies with the laws and regulations governing Federal healthcare programs (e.g., Medicare, Medicaid). This position is responsible for managing and/or conducting UVA Community Health’s professional and facility billing and coding investigations and reviews and conducting post-review education for UVA Community Health billing providers and departments. The position monitors and collaborates with compliance and operational staff across UVA Health entities (e.g., UVA Medical Center, UVA Community Health, UPG) and any external vendors hired to conduct compliance reviews relating to billing investigations or compliance work plans.

Works to prepare the annual risk assessment and compliance work plan. Conducts billing and coding-related investigations at UVA Community Health entities. Conducts and/or manages billing and coding reviews conducted pursuant to the Compliance and Privacy Office’s compliance work plan. Designs and performs billing and coding-related education and training. Collaborates with regulatory/compliance functions and staff throughout UVA Community Health to ensure that the compliance risk assessment captures operational risks and that mitigation plans are created and implemented as necessary. Manages (as applicable) billing and coding related reviews conducted by external vendors/auditors. Serves as the UVA Community Health Compliance and Privacy Office’s primary contact for billing and coding related questions and advice. Provides oversight and guidance to the development of policies and procedures surrounding documentation, charge capture, coding, and charge entry to ensure compliance with government and payer requirements and to ensure optimization of clinician revenue. Works with UVA Community Health departments to ensure timely refunds of any overpayments to Federal program payors. Prepares reports for the Compliance Committee, and recommends improvements / solutions, guidance, and remedies. Works in cooperation with the executive staff, physicians, and clinical department management to enhance billing quality in a manner that will ensure compliance with government regulations, payer requirements and optimize revenue for the clinical practice. Completes other projects and duties as assigned by Director and the Chief Corporate Compliance and Privacy Officer. Privacy is always maintained for patient and employee information. Actions are initiated to meet or exceed customer/co-workers expectations in delivering service. Appropriate resources throughout the Organization are used consistently to meet customer needs. Relationships with staff in other work areas are fostered to meet internal and external customer needs. Positive working relationships with peers, management and customers are always maintained. Participation in Performance Improvement activities and initiatives is on-going. Initiative is demonstrated to proactively diagnose and resolve problems. Change is met with positive, supportive behavior.

Communication: Demonstrates effective interpersonal communications skills. 

Engages in active listening, asking questions when appropriate.   Delivers engaging, informative, well-organized presentations when requested.   Effectively uses various technology communication methods to keep stakeholders informed of progress of projects and/or issues.  Maintains good working relationships and rapport with project stakeholders, as well as internal and external clients and or vendors. 

Teamwork: Seeks opportunities to increase business satisfaction and deepen relationships. 

Improves team performance by mentoring, training, and motivating in order to facilitate cooperation. 

Professional Competency: Enhances professional competency through continuing education and researching of material internally or externally. 

Demonstrates strong organizational and time management skills.   Uses critical thinking to assist in decision making and issue resolution.  Updates professional skills by taking educational classes as needed. 

The incumbent may be asked to perform additional duties as assigned.

 

QUALIFICATIONS

Education: Bachelor’s Degree Preferred

Experience: 5 years of direct compliance audit and/or investigation experience in a physician and/or hospital billing environment or similar setting required. Experience in compliance hospital and physician billing required.

Refer to the Life Support Training Policy for additional details.

Licensure: Certified Professional Coder (CPC), AAPC or Certified Coding Specialist (CCS), AHIMA, required. Other similar coding certifications may be considered

 Additional Skills/Requirements Required: Personal computers, hardware, and software. Microsoft Office Programs (i.e., Teams, Windows, Outlook, Work, Excel, etc.). Video conferencing (WebEx, Zoom, etc). EPIC experience required. 

 Additional Skills/Requirements Preferred: Knowledge of general health care compliance and privacy regulations preferred. Knowledge of hospital and physician practice-specific health care laws and regulations preferred.

 

PHYSICAL DEMANDS

Physical Demand Code: 3A, Administration

Work Function/Activity: Sedentary to Light Physical Demand

The job requires frequent sitting, standing, walking, and bending/stooping. Frequent repetitive body movements. Proficient communicative, auditory, and visual skills. Attention to detail and ability to write legibly. Ability to lift/push/pull up to 20 lbs. occasionally. This job description may not include all assigned duties, responsibilities, or aspects of the job described. It may be amended at any time at the sole discretion of UVA Health Northern VA & Culpeper.

 

OTHER

May require the use of safety equipment, such as HEPA mask, for infection prevention: No On call responsibilities as directed: No Ability to travel between campus buildings, remote facilities, and out of town as needed: Yes