Job Title & Specialty Area: Sr Billing Compliance Analyst

Department: Compliance & Internal Audits 

Location: Must be a TX resident 

Shift: Full-Time 

Job Type: Hybrid (Full-day in office meetings once a week)

Why Children’s Health?
At Children's Health, our mission is to Make Life Better for Children, and we recognize that their health plays a crucial role in achieving this goal.

Through our cutting-edge treatments and affiliation with UT Southwestern, we strive to deliver an extraordinary patient and family experience, ensuring that every moment, big or small, contributes to their overall well-being.

Our dedication to promoting children's health extends beyond our organization and encompasses the broader community. Together, we can make a significant difference in the lives of children and contribute to a brighter and healthier future for all.

Summary:
The Senior Billing Compliance Analyst is responsible for ensuring compliance with applicable internal policies and procedures as well as as State and Federal regulations specific to documentation, charging, coding, and billing for multiple product lines (Medicaid, Medicare and Commercial). Position will coordinate compliance activities, including but not limited to: conducting retrospective coding and billing compliance audits, ensuring contractual and regulatory requirements are met, preparing documents for program integrity and payor audit responses, prepare and provide internal education and training on billing compliance requirements, provide research and investigation support for billing compliance consults, and contribute to regulatory change management process.

Responsibilities:
Maintains knowledge of system policies and organizational processes that support the seven (7) elements of an effective compliance program as defined by the Office of the Inspector General and at the direction of the VP Deputy Chief Compliance and Audit Officer and/or their designee.
Serves as a key department representative for potential payor audit program contacts and agencies, and prepare audit files, provide review support, and denial, appeal and education support and follow-up.
Develops general compliance educational activities. This includes preparing educational materials for various types of sessions.
Works with leaders in the implementation of Billing Compliance program initiatives, relevant guidelines and policies, identified corrective action, and any relevant regulatory change management processes/changes. This Includes participating on workgroups, project teams, tracking milestones of implementation and development, research, or engagement of required educational needs assessment.
Assists with internal monitoring and preparation of compliance reporting to present to Senior Compliance Leadership. Prepares initial drafts of various reports to senior management, including, but not limited to reports to the CHST governance group (ex. Board of Directors). Prepares materials/handouts for various Corporate Compliance workgroups or meetings.
Provides support to ensure that all billing compliance regulatory information is accurately communicated to our the CHST internal customers and stakeholders.
Supports Corporate Compliance program efforts and initiatives, by maintaining, and documenting in key program tools, workflows, reporting efforts, and other program activities. These tools and platforms include, but are not limited to: Reporting Incident Management, Conflicts of Interest reporting, Business Gifts and Courtesies, Training, Regulatory Navigator, Revenue Risk Manager, the Corporate Compliance hotline and SafeLink systems.
Coordinates with contractors, vendors, and delegated entities to provide assistance on key Corporate Compliance initiatives and ensure adherence to all regulations and contractual agreements.
Analyzes statistical data and reports to identify and determine health care compliance issues
Able to research state (Medicaid) and Federal (CMS) regulations to respond to internal inquiries and communicate via regulatory change management process.
Conducts retrospective coding & billing audits per internal department workplan and develops billing compliance educational activities which include preparing educational materials for various types of training sessions or offerings including required annual Compliance training.
Assesses and recognizes self-development needs. Seeks out resources or experiences which promote professional growth and development.

WORK EXPERIENCE
At least 3 years Relevant healthcare industry experience or equivalent experience in another highly regulated environment Required
At least 2 years Working knowledge of compliance, auditing and monitoring techniques and standards Preferred
At least 2 years Experience in Revenue Cycle or Health plan setting Preferred
At least 1 year Experience auditing activities and interacting with auditors and government agencies Preferred

EDUCATION
Four-year Bachelor's degree or equivalent experience Required
Graduate or professional work or advanced degree; or equivalent experience Preferred

LICENSES AND CERTIFICATIONS

Certification Certified Professional Medical Auditor (CPMA), Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC) Certified Coding Specialist (CCS), Certified Coding Associate (CCA), or nursing license (RN/BSN) (Other relevant Revenue Cycle certifications or Clinical licenses will be considered) Required. 

Healthcare Compliance or equivalent Corporate Compliance Certification (ex. CHC, CHRC, CHPC, CHC-F, or CCEP) - at time of hire, or within 3 years of hire Upon Hire Preferred

A Place Where You Belong

We put our people first. We welcome, value, and respect the beliefs, identities and experiences of our patients and colleagues. We are committed to delivering culturally effective care, creating meaningful partnerships in the communities we serve, and equipping and developing our team members to make Children’s Health a place where everyone can contribute.

 Holistic Benefits – How We’ll Care for You:

· Employee portion of medical plan premiums are covered after 3 years.

· 4%-10% employee savings plan match based on tenure

· Paid Parental Leave (up to 12 weeks)

· Caregiver Leave

· Adoption and surrogacy reimbursement 

As an equal opportunity employer, Children's Health does not discriminate against employees or applicants because of race, color, religion, sex, gender identity and expression, sexual orientation, age, national origin, veteran or military status, disability, or genetic information or any other Federal or State legally-protected status or class. This applies to all aspects of the employer-employee relationship including but not limited to recruitment, hiring, promotion, transfer pay, training, discipline, workforce adjustments, termination, employee benefits, and any other employment-related activity.