Senior Billing Compliance Analyst

Full Time Days Must have RECENT (last 3-5 years) Epic HB or PB Billing Compliance experience.

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.

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

None. Certified Healthcare Compliance (CHC) from the Healthcare Compliance Association (HCCA), preferred.

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

• 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.

• 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.

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

• 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.

None.

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

EOE Protected Veterans/Disability

Saint Francis is a Catholic, not-for-profit Health system based in Tulsa, Oklahoma. We are the largest private employer in Eastern Oklahoma with over 12,000 employees, including 1,000…