JOB SUMMARYThe Compliance Analyst III conducts complex professional billing and coding compliance audits and reviews, including evaluation of medical record documentation, coding, billing, modifiers, medical necessity, and other reimbursement requirements. Evaluate provider billing practices for compliance with applicable federal and state requirements, payer requirements, and institutional policies and procedures. Perform risk-based and targeted reviews involving higher-risk professional billing areas, including evaluation and management services, procedural services, teaching physician requirements, split/shared services, incident-to billing, modifiers, time-based services, and other specialty-specific billing requirements. Analyze claims, coding, reimbursement, and other data to identify trends, outliers, potential overpayments, and emerging compliance risks requiring further investigation or monitoring.
This position operates on a hybrid work schedule, with a minimum of two days per week in the office (Monday and Wednesday) and additional on-site attendance as business needs require.
BENEFITSUT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include:
- PPO medical plan, available day one at no cost for full-time employee-only coverage
- 100% coverage for preventive healthcare-no copay
- Paid Time Off, available day one
- Retirement Programs through the Teacher Retirement System of Texas (TRS)
- Paid Parental Leave Benefit
- Wellness programs
- Tuition Reimbursement
- Public Service Loan Forgiveness (PSLF) Qualified Employer
- Learn more about these and other UTSW employee benefits!
EXPERIENCE AND EDUCATIONRequired- Education
Bachelor's Degree in business or healthcare administration, regulatory compliance, consulting, project management, or related area
- Experience
5 years of professional experience in a compliance-related field.
Preferred- Licenses and Certifications
Compliance Certification
JOB DUTIES- Serves as team leader and project manager while conducting complex assurance/effectiveness reviews or other department projects, including the establishment of goals, objectives, timelines and quality measures for the team's work and deliverables.
- Conducts complex assurance/effectiveness reviews of compliance activities in accordance with appropriate standards, metrics, established compliance plan(s) and prescribed departmental/unit/program policies.
- Evaluates effectiveness of compliance controls used by reviewed department/unit/program, as well as compliance with all applicable university policies and procedures.
- Prepares compliance reports and is capable of providing supporting evidence and defend the findings and recommendations made regarding identified compliance deficiencies or gaps.
- Assists in investigations of alleged breaches of policy, misconduct or other acts of non-compliance to determine the cause, extent of loss and mechanisms for prevention.
- Maintains effective working relationships with compliance personnel to achieve objectives of assurance-related assignments.
- Remains abreast of current developments in compliance.
- Develops and maintains compliance-related education and training materials and, when necessary, conducts training sessions on compliance-related topics.
- Performs other duties, as assigned.
