FLSA Status: Exempt, Non-Bargaining Unit Position
POSITION SUMMARY: Responsible for organizing, managing and trending data for both project and operational purposes within the UWP Compliance Department. The position is a key resource for the entire compliance team, who will depend on the technical and analytical skills of this position. In addition to these skills, an ideal person in this role will be able to communicate effectively, translating complex data into manageable information. Good planning for & forecasting of needs will minimize the need for tight deadlines, which occur periodically. The successful candidate will have an exciting opportunity to work with data in various formats and sources and will help define this new position for UWP.
ESSENTIAL RESPONSIBILITIES:
- Is the System Administrator for the Compliance Audit System. Manages the access control process, including the assignment and cancellation of passwords. Responsible for the orientation and training of Compliance Department staff on Compliance Audit System usage. Keeps staff aware of system updates and changes. Notifies Manager, Compliance Auditing and Monitoring of system usage issues with identified individuals. Monitors audit trail reporting for appropriate safeguards of PHI and system performance trends.
- Perform daily management of Compliance Audit System including trouble-shooting system performance issues.
- Is the Compliance Department liaison with Compliance Audit System vendor(s). Participates in system enhancement design process and recommends to the Manager, Compliance Auditing and Monitoring changes for UWP Compliance Department audit workflow efficiency and reporting effectiveness.
- Coordinates off-site Compliance Audit workflow including remote access connectivity process, data input from coding contractors and transfer of initial audit work to appropriate Compliance Department staff for further work.
- Maintains records of coding contractor work assignments and tracks for timely completion. Provides weekly reports to Manager, Compliance Auditing and Monitoring and immediate reports on urgent issues/concerns.
- Participates in conferences with coding contractors regarding work performance monitoring and issues.
- Prepares routine reports on auditing activity for the Chief Compliance Officer which include audit time period, audit sample, preliminary and final findings, and status reports on timeliness and dependency issues. Develops and prepares ad hoc reports to assist with risk assessment and Compliance Program monitoring. The reports would include profiling of audit findings by departments, providers, time periods, issues identified or other parameters.
- Assesses the request and determines most appropriate data source. Combines data from multiple sources for effective roll up reporting.
- Provides analytical and report generation support for comparative analysis of Provider billing compliance, using CMS Billing performance data, UHC academic medical center data and other sources.
- Assists the Chief Compliance Officer and Compliance Department Managers with project management by building Gantt and PERT charts for defined projects. Maintains critical path reporting for projects as requested. Is Department resource for flow charts, organization charts and other graphical charting needs.
- Responsible for maintaining knowledge and understanding of UWP Compliance policies and assessing needs for additional data tracking and reporting. Establishes standards and maintains the Compliance Department on-line shared files. Maintains working knowledge of coding schemas and medical terminology in order to Assess data requests to formulate appropriate data query (e.g., request for medical necessity data would involve both CPT and ICD-9-CM codes and request for compliance error rate requires analysis and clarification of coding error versus net financial error rate as appropriate to the need for the data.)
STANDARD JOB RESPONSIBILITIES:
- Conduct business with employees, patients, the School of Medicine, the physicians and outside parties in a professional appropriate manner conducive to maintain good working relations.
- Ability to follow all UWP policies regarding security and confidentiality.
- Conduct all activities with safety in mind.
- Sustain a good workplace attitude.
- Must be prompt and dependable in attendance.
- Adhere to all company policies and procedures.
- Represent your employer confidentially and professionally at all times.
The responsibilities listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position.
REQUIRED QUALIFICATIONS:
- Bachelor’s degree or an equivalent combination of education and experience.
PREFERRED QUALIFICATIONS:
- Experience in a healthcare billing organization.
KNOWLEDGE/SKILLS/ABILITIES:
- Ability to analyze information and evaluate results to choose the best solution and solve problems.
- Ability to evaluate current workflows and processes with a critical eye and develop proposals for improvement.
- Ability to interpret physicians’ documentation and identify/extract billable services from medical records.
- Ability to understand and analyze system connections and impacts, both internal and external, for a large healthcare organization.
- Ability to use relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards.
- Ability to utilize root-cause analysis to make process improvement decisions and implement change.
- Ability to work effectively with electronic records systems such as Cognos, MD Audit, ORCA, and EPIC to research and gather information for audits and special projects.
- Consistent exercise of discretion and judgment.
- Excellent oral and interpersonal communication skills, with the ability to convey a positive and professional image in person, and to interact effectively with diverse personalities and backgrounds.
- Knowledge of CMS/HCFA and/or teaching physician documentation standards.
- Knowledge of ICD9, CPT and HCPS coding and medical terminology.
- Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
- Must be highly organized, detail oriented, and able to manage multiple competing priorities with a high degree of speed and accuracy.
- Proficiency with Windows based software and Microsoft Office Suite products in a network environment.
- The ability to absorb information and form general rules or conclusions (including finding relationships among seemingly unrelated events); and to apply general rules to specific problems to produce answers that make sense.
- Use logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
- Using relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards.
COMPLIANCE REQUIREMENTS: All non-management positions require adherence to the UWP Code of Conduct and UWP Billing Compliance Policies and related training requirements. Incumbents must demonstrate knowledge and understanding of the confidentiality of employee information, UWP plans, initiatives, and financial information, and patient privacy rights. Job duties must be performed with minimum access to and use of UWP, employee, and/or patient information. Incumbents are required to promptly report all compliance concerns.
WORKING CONDITIONS: Work is performed within a normal office environment with ambient temperatures and involving occasional reaching, stretching, bending, and moving about.
SELECTION: Selection is based on the candidate meeting the required qualifications, demonstration of related experience and/or education, favorable attainment of references, and the candidate's ability to fulfill the described job responsibilities.
APPLICATION: To apply for this position, please complete this Equal Employment Opportunity Affirmative Action Form. After completing the form you will be provided with further instructions for submitting your cover letter and resume to complete the application process. If you are applying for more than one position, please complete this process for each position.
EQUAL OPPORTUNITY EMPLOYER