[Hiring] Senior Billing Compliance Analyst @Saint Francis Health System

Role Description

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.

• Leads audit initiatives
• Identifies systemic risk areas
• Supports investigations
• Develops training content
• Advises on regulatory changes
• Recommends process improvements that enhance compliant billing practices across the organization

Qualifications

• 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 ICD-10-CM, CPT, and HCPCS coding systems, guidelines, and federal/state billing regulations
  • Strong understanding of CMS billing guidelines, 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
  • Ability to present complex information to leadership
  • Strong data analysis capabilities, including working with large datasets, financial modeling, and root-cause analysis

Requirements

• Conducts and manages Hospital and Professional billing compliance audits, reviews, projects, and investigations
• Ensures that all written reports and correspondences are organized, accurate, and professional
• Identifies significant issues within the scope of audits/reviews/projects/investigations
• Develops ongoing billing compliance training and awareness initiatives
• Analyzes and evaluates information related to the regulatory healthcare environment
• 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

Company Description