Compliance Analyst II

Job Overview Job Location: 601 Elmwood Ave, Rochester, New York, 14642, United States of America. Position: Worker Subtype: Regular Time. Type: Full time. Scheduled Weekly Hours: 40. Department: 900017, Compliance Office. Work Shift: UR - Day (United States of America). Range: UR URG 111. Compensation Range: $63,815.00 - $95,723.00. The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries or hourly rates will be set within the compensation range, based on market data, education, experience, qualifications, expertise, and internal equity considerations. Responsibilities Provides compliance oversight and support for assigned clinical specialties across URMC and Affiliates following OIG and OMIG guidance. Evaluates adherence to coding and billing regulations through review, research, and analysis. Serves as a compliance resource, developing and delivering comprehensive education and training. Conducts investigations, risk assessments, and regulatory monitoring to prevent and detect fraud, waste, and abuse, addressing the DRA, NY SSL section 363-d, and 18 NYCRR SubPart 521. Maintains a high degree of accuracy, professional judgment, and accountability to avoid regulatory or financial penalties and reputational risk. Analyzes billing data to identify potential risk areas in professional and facility payment systems. Performs audits of medical record documentation to ensure compliance with coding and billing requirements as defined by AMA, AHA, HCPCS, CMS, and Medicaid guidelines. Creates and provides reports on findings to relevant stakeholders. Responds to reported compliance concerns by conducting formal investigative activities. Assesses and documents allegations of non‑compliance in the department’s case management system. Plans and strategizes investigations, collecting and analyzing documents, data, electronic records, billing and clinical documentation, and other relevant materials. Conducts interviews with reporters, witnesses, and implicated individuals. Reviews facts in the context of applicable coding, billing, and regulatory requirements. Performs root cause analysis when deficiencies are identified. Collaborates with stakeholders to determine improvement opportunities to mitigate future risk. Collaborates with OIC leadership to determine corrective action such as formal self‑disclosures or claim adjustments. Develops and delivers education and training sessions for faculty, residents, and staff on coding, Medicare, Medicaid, and third‑party payer regulations, and fraud, waste, and abuse prevention. Serves as a resource and subject matter expert for URMC and Affiliate personnel, offering guidance on billing, coding, and reimbursement matters. Assists with due diligence activities related to physician practice and provider acquisitions directed by OIC leadership and/or Office of Counsel. Assists in assessing and responding to external audits and government investigations. Participates in special projects and investigations as directed by compliance leadership or Office of Counsel. Maintains up‑to‑date knowledge of compliance risks through professional associations, peer networking, literature review, and industry seminars. Performs other duties as assigned. Minimum Education & Experience Bachelor or Associate’s degree in a related field preferred. Equivalent combination of education, professional certification(s), and substantial relevant experience considered. Minimum three years of healthcare coding experience, including APG, APC, and/or DRG coding methodologies or specialty area coding and billing. Experience in a direct or supporting role within healthcare compliance, preferably in an integrated health system or academic medical center. Knowledge, Skills, and Abilities Strong communication, interpersonal, and public speaking skills. Ability to efficiently produce clear, concise, and complete written audit reports. Excellent analytical, organizational, and problem‑solving skills. Demonstrated objectivity and critical thinking, evaluating facts without bias and avoiding unsupported assumptions. Project management skills and ability to advise staff in a motivating and positive manner. Willingness to collaborate with others and work as part of a team. Ability to maintain high discretion and confidentiality with sensitive information. Experience creating, editing, and manipulating data and documents using Microsoft Office. Licenses and Certifications Required: RHIT, RHIA, CCS or CCS‑P, CPC, COC, or equivalent professional certification. Preferred: Certified in Healthcare Compliance (CHC). Equal Opportunity Statement The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture. We do not discriminate on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military or veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law. #J-18808-Ljbffr