Billing Compliance Analyst

Full Time

Days

Job Summary: The Billing Compliance Analyst supports the health system’s compliance efforts by performing audits, data analysis, and monitoring activities to ensure accurate billing, charging, and coding practices. This role works closely with billing teams, coding teams, compliance leadership, and clinical departments to promote adherence to federal, state, and commercial payer regulations. The analyst plays a key role in assisting in training initiatives, creating prevention action plans, developing reports, identifying risk areas, and supporting investigations.

Minimum Education: High School Diploma or GED. Bachelor’s degree in Business, Health Information Management, Healthcare Administration, or related field, preferred.

Licensure, Registration and/or Certification: Certified Healthcare Compliance (CHC) from the Healthcare Compliance Association (HCCA), preferred.

Work Experience: Minimum 3 years of Healthcare Billing, Coding, or Compliance. Audit Process and Data Analysis experience, preferred.

Knowledge, Skills, and Abilities: 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 and guidelines. Familiarity with Center for Medicare and Medicaid Services (CMS) billing regulations and payer-specific policies. Knowledge of Microsoft 365 and other applicable software. Basic knowledge of electronic health record (EHR) systems. Strong analytical skills with attention to detail and accuracy. Excellent communication skills, both written and verbal that present clear and concise information. Ability to work independently and collaboratively in a fast-paced environment, managing multiple priorities with competing deadlines.

Essential Functions and Responsibilities: Conducts audits and reviews of inpatient, outpatient, and professional billing, charging, and coding practices to ensure compliance with applicable laws, regulations, and internal policies. Assists in the development of audit tools, methodologies, and sampling plans. Analyzes audit results, identifies trends and risk areas, assists in prevention plans, and assists in preparing summaries and reports for senior leadership. Supports the implementation and tracking of corrective and prevention action plans in response to audit findings. Participates in investigations of suspected non-compliant billing practices by performing data reviews, chart audits, and charging analysis. Assists with maintaining tracking systems for compliance activities and audit results. Stays current on industry updates, payer guidance, and regulatory changes related to billing and coding. Contributes to the creation and delivery of educational materials and training sessions. Collaborates with other departments including clinical operations, coding, Health Information Management (HIM), and revenue integrity to support audit processes and ensure resolution of findings.

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

Working Relationships: Coordinates activities of others (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.

Patient Accounting - Yale Campus

Location:

Virtual Office, Oklahoma 73105