Analyst, Compliance

Analyst, Compliance

The Analyst, Compliance is responsible for assisting with oversight and advancement of CUIMC's professional fee compliance, billing integrity, and regulatory adherence programs. This position serves as a subject matter expert on complex coding, billing, and reimbursement matters, ensuring compliance with CMS regulations, federal and state laws, and applicable coding guidelines. The position provides advisory guidance for coding audits, documentation reviews, provider education, risk assessments, regulatory monitoring, and corrective action initiatives designed to promote compliant billing and reduce regulatory risk.

Responsibilities

• Provide oversight and perform, as needed, ongoing, risk-based, and ad hoc coding auditing of complex services, across multiple specialties, rendered by physician and non-physician practitioners using current coding guidelines, with attention to Medicare/Medicaid, medical necessity, and NCD/LCD requirements; including but not limited to retrospective audits for established providers and prospective audits for newly onboarded providers to ensure appropriate documentation, coding accuracy, and billing compliance.
• Manage departmental compliance teams under the leadership of the Sr. director and Chief Compliance Officer.
• Collaborate closely with the central revenue office and departmental compliance teams to address revenue and billing integrity needs.
• Support departmental compliance teams by providing advisory guidance and expert knowledge of CPT/HCPCS and ICD-10 guidelines across multiple specialties, as well as teaching facility guidance, professional fee billing, including global surgical package rules, modifier usage, incident-to services, split/shared services, and emerging regulatory changes.
• Assist with managing CUIMC's annual compliance work plan.
• Assist with CUIMC's annual education curriculum and monthly Compliance Forums ongoing education and training.
• Assist in the development and delivery of educational sessions related to coding, documentation, and payer-specific billing requirements for physicians and billing personnel.
• Collaborate with the central revenue office, clinical staff, providers, and administrative personnel to address compliance issues.
• Assist with development and management of compliance policies and procedures.
• Assist Compliance Leadership with other assignments and related compliance responsibilities as needed.

Minimum Qualifications

• Bachelor's degree or minimum four(4) years of direct experience in healthcare professional fee billing, coding, and/or compliance, preferably in an academic medical center or large healthcare system.
• Current credential of CPC/CCS-P or related coding professional credential required.
• Expert knowledge of Evaluation and Management (E/M) guidelines and surgical coding in multiple specialties with preference in orthopedics, surgery, and cardiology; and high-working knowledge in more.
• Epic electronic health record experience.
• Experience in using one or more audit tools, (e.g. Audit Manager, MDAudit, etc.).
• Excellent analytical skills and communication skills, both oral and written, including Microsoft Office advance proficiency.
• Excellent project management skills and time management. Must be self-starter, work autonomously, and self-disciplined.

Preferred Qualifications

• Bachelor's degree in Health Information Management, Health Administration, Business, Finance, or a related field, or an equivalent combination of education and experience.
• Certified Professional Medical Auditor (CPMA).

Equal Opportunity Employer / Disability / Veteran

Columbia University is committed to the hiring of qualified local residents.