Compliance Analyst II, URMC and Affiliates
University of RochesterRochester, NY, US3 days ago
Job type
- Full-time
Job descriptionProvides compliance oversight and support across URMC and Affiliates in accordance with OIG and OMIG compliance program guidance. Evaluates adherence to regulations, laws, and guidelines through review, research, and analysis. Serves as a compliance resource, developing and delivering comprehensive education and training. Responds to reported compliance concerns by conducting formal investigative activities. Performs root cause analysis when deficiencies are identified. Collaborates with relevant stakeholders to determine improvement opportunities to mitigate future risk. Collaborates with OIC leadership to determine corrective action, such as formal self-disclosures or claim adjustments. Assists in responding to external audits and government investigations as directed. Participates in special projects and investigations as directed by compliance leadership and / or Office of Counsel. Maintains up-to-date knowledge of compliance risks by engaging in professional associations, networking with peers at other academic medical centers, reviewing relevant literature, and participating in industry seminars and educational events. Performs other duties as assigned Analyzes billing data to identify potential risk areas related to professional and / or facility payment systems. Performs audits of medical record documentation to ensure compliance with coding and billing requirements as defined by AMA, AHA, HCPCS, CMS, and Medicaid guidelines. Creates and provides reports on findings to relevant stakeholders. Plans and strategizes each investigation, collects and analyzes documents, data, electronic records, billing and clinical documentation, and other relevant materials. Conducts interviews with reporters, witnesses, and implicated individuals. Reviews facts in the context of applicable coding, billing, and regulatory requirements. Develops and delivers comprehensive education and training sessions for faculty, residents, and staff, covering essential topics such as coding, compliance with Medicare, Medicaid, and third-party payer billing regulations, and fraud, waste, and abuse prevention. Serves as a resource and subject matter expert for URMC and Affiliate personnel, offering guidance on billing, coding, and reimbursement matters Assists in due diligence activities related to physician practice and provider acquisitions as directed by OIC leadership and / or Office of Counsel. Plans and strategizes each investigation, collects and analyzes documents, data, electronic records, and other relevant materials. Conducts interviews with reporters, witnesses, and implicated individuals. Reviews facts in the context of applicable regulatory requirements Coordinates and conducts risk assessments and audits for compliance categories, including, but not limited to, effective compliance program elements and governance, payments (grants, waivers, financial statements, billing), credentialing, privileging, Stark Law, Anti-Kickback Statute, exclusions, Conflict of Interest, and vendor / contractor ethical relationships. Creates and provides reports on findings to relevant stakeholders. Serves as a resource to URMC and Affiliates by researching and interpreting healthcare regulations. Creates, updates, and provides OMIG mandatory educational content and training for affected individuals on relevant compliance topics. Creates, reviews, and updates compliance program policies and procedures Assists with compliance committee and board meeting preparation at the direction of the compliance leadership Minimum Education - Bachelors degree in a related field. Equivalent combination of education, professional certification(s), and substantial relevant experience will also be considered Experience Minimum of 3 years of healthcare coding experience required, to include APG, APC, and / or DRG coding methodologies or professional coding and billing in specialty areas. Experience in a direct or supporting role within healthcare compliance, preferably within an integrated health system, an Academic Medical Center, or other comparable setting preferred. Certifications One of the following credentials is preferred : Registered Health Information Technologist (RHIT), Registered Health Informational Administrator (RHIA), Certified Coding Specialist (CCS or CCS-P), Certified Professional Coder (CPC), Certified Outpatient Coder (COC), or equivalent professional certification. Certified in Healthcare Compliance (CHC) Minimum Education - Bachelors degree in a related field. Equivalent combination of education, professional certification(s), and substantial relevant experience will also be considered Experience Minimum of 3 years of experience in a direct or indirect healthcare compliance role in an integrated health system or a comparable healthcare setting. Certifications One of the following credentials is preferred : Certified in Healthcare Compliance (CHC), Certified Compliance & Ethics Professional (CCEP), Certified Fraud Examiner (CFE), Certified Internal Auditor (CIA), or equivalent professional certification. Strong communication, interpersonal, and public speaking skills. Ability to efficiently produce clear, concise, and complete written audit reports. Excellent analytical, organizational, and problem-solving skills. Demonstrated objectivity and critical thinking in analyzing situations; must be able to evaluate facts without bias and avoid unsupported assumptions. Ability to manage projects and effectively advise staff in a motivational and positive manner. Willingness to collaborate with others and to work as part of a team. Ability to maintain high discretion and confidentiality with sensitive information. Experience creating, editing, and manipulating data and documents using Microsoft Office. Ability to effectively use compliance monitoring and documentation systems.
Compliance Analyst II
The University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share : equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.
Job Location : 175 Corporate Woods, Rochester, New York, United States of America, 14623
Opening : Regular
Time Type : Full time
Scheduled Weekly Hours : 40
Department : 900017 Compliance Office
Work Shift : UR - Day (United States of America)
Range : UR URG 111
Compensation Range : $63,815.00 - $95,723.00
Responsibilities
The Compliance Analyst II conducts investigations, risk assessments, and regulatory monitoring to prevent and detect fraud, waste, and abuse, specifically addressing the DRA, NY SSL 363-d, and 18 NYCRR SubPart 521. Requires a high degree of accuracy, professional judgment, and accountability, as errors can result in significant regulatory or financial penalties or reputational risk.
There are two pathways for the Compliance Analyst II :
1 : Compliance Billing, Coding, and Education Analyst
- Provides compliance oversight and support for assigned clinical specialties across URMC and Affiliates in accordance with the OIG and OMIG compliance program guidance.
- Evaluates adherence to coding and billing regulations and guidelines through review, research, and analysis.
- Serves as a compliance resource, developing and delivering comprehensive education and training.
2 : Compliance Specialist
Compliance Analyst II General Responsibilities :
1 : Compliance Billing, Coding, and Education Analyst Responsibilities :
2 : Compliance Specialist :
Qualifications
1. Compliance Billing, Coding, & Education Analyst
2. Compliance Specialist
Knowledge, Skills & Abilities
The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the Universitys Mission to Learn, Discover, Heal, Create and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military / veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.
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Compliance Analyst Ii • Rochester, NY, US
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