As a UW employee, you have a unique opportunity to change lives on our campuses, in our state and around the world. UW employees offer their boundless energy, creative problem solving skills and dedication to build stronger minds and a healthier world.
UW faculty and staff also enjoy outstanding benefits, professional growth opportunities and unique resources in an environment noted for diversity, intellectual excitement, artistic pursuits and natural beauty.
UW Medicine has an outstanding opportunity for a Professional Billing Compliance Analyst.
In general, UW Medicine Compliance Analysts are responsible for performing daily activities required to fulfill the goals, audit plans, work plans, initiatives, and duties related to a specific Compliance program element or content area. All Analysts maintain a skill set tailored to their respective content area in order to research and analyze unit-specific issues and concerns, including complaints. Analysts conduct audits and/or analyze data, prepare reports pursuant to the unit’s audit plan, and participate in the development and implementation of follow-up education, outreach, and/or other corrective actions.
Analysts contribute to compliance program development by maintaining data for unit reports, participating in the development and/or delivery of educational and outreach materials, and maintaining unit records. Analysts maintain current knowledge of applicable laws and regulations and may contribute to the unit’s risk assessments and risk mitigation strategies.
All Compliance Analysts function as part of a unit team to accomplish unit goals, and work cooperatively with other compliance staff and entity staff as needed to resolve shared issues and concerns. In addition, they may participate in committees, workgroups, or process improvement projects as assigned.
The Professional Billing Compliance Analyst is responsible for audits that assess the accuracy of documentation, coding, and billing against federal regulations (Medicare) and other laws and state laws and regulations that may apply.
Reporting to the Billing Compliance Manager, Analysts for the Billing Compliance Unit conduct daily activities pursuant to the unit’s goals, audit plan, and work plan. Analysts in the unit have regular interaction with clinic managers, revenue cycle staff, and Patient Financial Services staff.
Specific Duties and Responsibilities
Perform audits, analyze results, and write audit reports
Provide feedback and education on the results of audits and collaboratively establish corrective action plans
Review claims denials to assess coding and medical necessity issues
Investigate billing and coding issues as related to inquiries, complaints, or audit results
Serve as a resource for current documentation, coding, billing and related regulatory guidelines
Consistently delivers on commitments and promises;
Sets own standards of excellence instead of waiting for standards to be imposed;
Accepts responsibility for outcomes (positive or negative) of one’s judgments or actions; admits mistakes and refocuses efforts when appropriate;
“Owns” organizational and higher level leadership decisions.
Exercising Good Judgment
Follows established guidelines and policies when making decisions and demonstrates sound judgment in making decisions when there is no precedent/guideline.
Demonstrates technical/professional mastery of skills and knowledge required for the position.
Considers problems from all perspectives, and thoughtfully and responsibly considers all relevant impacts and implications before making a decision;
Makes effective and timely decisions, even when data are limited and without unnecessarily referring to others;
Recognizes who needs to be involved in decisions and engages them when appropriate.
Demonstrates a sincere, positive attitude toward helping others and getting things done; doesn’t say “it’s not my job.”
Develops and promotes positive working relationships with colleagues;
Seeks out, listens to, and considers the ideas and opinions of others;
Works cooperatively with others to develop and implement programs and ideas;
Shares information and expertise with others to accomplish mutual goals;
Understands the impact of actions/decisions on other individuals/departments/stakeholders.
Additional UWM Compliance Competencies for Supervisory and Leadership Positions:
Critical Thinking Skills
Incorporates relevant research findings and other evidence into practice;
Applies critical thinking and problem solving skills;
Applies sound professional judgment;
Recognizes the limits of own role and competence, and consults with a professional who has required expertise when issue requires expertise beyond own current competence or scope;
Accurately interprets objective and subjective data and their significance.
Sets clear standards for service, quality, and other key performance areas;
Regularly monitors performance against established standards;
Provides ongoing feedback on performance and offers appropriate guidance;
Holds employees accountable for achieving performance standards;
Rewards and recognizes exemplary performance; appropriately addresses poor performance.
Bachelor’s degree in a Health Sciences discipline, Business administration, or related field.
Minimum of five years experience with healthcare billing and coding operations or compliance.
Coding, documentation and reimbursement content area expertise in one or more of the following: utilization management, medical necessity, inpatient coding, or outpatient coding.
Current coding certification, particularly RHIT, CCS and/or CPC.
Expert knowledge of healthcare billing and coding (specifically ICD-9-CM, ICD-10- CM, CPT and HCPCS coding principles and guidelines) to provide support services to providers and entity coding staff; and to be effective in daily audit duties.
Comprehensive knowledge of federal and state regulations related to documentation, coding and billing.
Proficiency with Microsoft products.
Demonstrated ability to analyze and distill complex audits and make recommendations, both verbal and in writing, based on findings.
Effectively communicate and present subject matter material to providers sufficient to advance their comprehension of compliance regulations.
Self-motivated, detail-oriented and highly organized skill set.
Equivalent education and/or experience may substitute for minimum requirements.
Experience in an academic healthcare environment.
Proficiency with electronic medical records systems, databases, and related automated systems.
Certified in Healthcare Compliance (e.g. HCCA/HCCB CHC certificate).
CONDITION OF EMPLOYMENT UW Medicine Compliance manages a significant volume of audits, inquiries and consultations. Work priorities shift in response to fluctuating demands. Full time schedules are assumed to be at least 40 hours, however, incumbents are expected to remain flexible to accommodate the unit's goals and mission, and to work beyond their normal schedule when necessary.
Founded in 1861, the University of Washington is one of the oldest public institutions in the west coast and one of the preeminent research universities in the world. The University of Washington is a multi-campus university comprised of three different campuses: Seattle, Tacoma, and Bothell. The Seattle campus is made up of sixteen schools and colleges that serve students ranging from an undergraduate level to a doctoral level. The university is home to world-class libraries, arts, music, drama, and sports, as well as the highest quality medical care in Washington State and a world-class academic medical center. The teaching and research of the University’s many professional schools provide undergraduate and graduate students the education necessary toward achieving an excellence that will serve the state, the region, and the nation. As part of a large and diverse community, the University of Washington serves more students than any other institution in the Northwest.