Senior Billing Compliance Analyst

Job Summary: The Senior Billing Compliance Analyst provides advanced support to the health system’s billing compliance program by performing complex audits, leading data analytics activities, and guiding prevention and monitoring strategies. This role serves as a subject matter expert on billing, charging, and coding compliance, collaborating with operational leaders, compliance leadership, coding teams, revenue cycle, and clinical departments. The senior analyst leads audit initiatives, identifies systemic risk areas, supports investigations, develops training content, advises on regulatory changes, and recommends process improvements that enhance compliant billing practices across the organization.

Minimum Education: High school diploma or GED. Bachelor’s degree in Business, Healthcare Administration, or Health Information Management, preferred.

Licensure, Registration and/or Certification: None. Certified Healthcare Compliance (CHC) from the Healthcare Compliance Association (HCCA), preferred.

Work Experience: Minimum 5 years of experience in Healthcare Billing, Coding, or Compliance. Audit Process and Data Analysis experience, preferred.

Knowledge, Skills, and Abilities: Advanced knowledge of 10th Revision of the International Classification of Diseases (ICD-10-CM), Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding Systems (HCPCS) coding systems, guidelines, and federal/state billing regulations. Strong understanding of Center for Medicare and Medicaid Services (CMS) billing guidelines, Office of the Inspector General (OIG) work plan focus areas, and payer-specific policies. Advanced knowledge of Epic, charge router logic, clinical workflows, and charging methodologies. Knowledge of Microsoft 365 and other applicable software. Excellent communication skills, both written and verbal that present clear and concise information. Ability to present complex information to leadership. Strong data analysis capabilities, including the ability to work with large datasets, financial modeling, and root-cause analysis.

Essential Functions and Responsibilities: Conducts and manages Hospital and Professional billing compliance audits, reviews, projects and investigations. Ensures that all written reports and correspondences are organized, accurate, appropriate in content, professional in appearance and effectively conveys the reported issue. Identifies significant issues within scope of the audit/review/project/investigation ensuring billing compliance with appropriate statutes, rules and regulations. Develops on-going billing compliance training and awareness initiatives. Analyzes and evaluates information related to the regulatory healthcare environment by monitoring the appropriate state, federal and industry websites, publications, and journals. Develops billing compliance related documents including stakeholder input, review, and approval. Analyzes and evaluates data, identifies risks, and makes appropriate conclusions based on audit test work, investigations, and project analysis. Manages the Billing Compliance Program Policy and Procedures life cycle process. Provides subject matter expertise by recommending updates to policies and procedures, best practices, and implementation guidance.

Decision Making: Independent judgment in making decisions involving non-routine problems under general supervision.

Working Relationships: Coordinates activities of others (does not supervise). Coordinates and leads others in same work performed (does not supervise). Works directly with patients and/or customers. Works with internal and/or external customers via telephone or face to face interaction. Works with other healthcare professionals and staff. Works frequently with individuals at Director level or above.

Special Job Dimensions: None.

Supplemental Information: This document generally describes the essential functions of the job and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.

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