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Compliance Analyst Hospital

San Francisco, CA

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Job Description:
Are you experienced in a hospital revenue cycle setting and certified in RHIA, RHIT or CCS? Do you have expert knowledge with ICD-10 or CPT/HCPCS coding guidelines/conventions and applying your knowledge in varied clinical settings? If so, we want to speak with you!
The Compliance Analyst - Hospital supports the efforts of the Revenue Cycle Compliance component of the UCSF Clinical Compliance Program through adherence and promotion of functions that support the seven elements of an effective compliance program.
The Analyst conducts coding and billing compliance audits to determine compliance of hospital coding and billing practices in accordance with relevant laws, regulations, and policies. Communicates compliance audit results to Physicians, Non-Physician Providers, Hospital Operations Leadership and Staff as well as develops and provides education and/or training based upon audit findings. Functions as a subject matter expert and authoritative resource for interpretation and application of documentation, coding and billing rules and regulations for hospital settings. May provide advice and assistance to other Compliance Analysts with revenue cycle, compliance functions pertaining to Professional Fee and/or Hospital settings.
Remote working opportunity. $1,500 sign on bonus with 1 year commitment.

UCSF Clinical Compliance Program is responsible for implementation of an effective compliance program, consistent with the U.S. Federal Sentencing Guidelines and guidance of the Health and Human Services (HHS) Office of the Inspector General. The Program is responsible for the promotion of a comprehensive approach to compliance with health care laws, regulations, and policies across the UCSF clinical enterprise, which includes a leading academic medical center, outpatient clinics, professional services, and clinical schools. The Program develops, implements, and enforces University policy related to UCSF clinical operations and supports methods of preventing and detecting inappropriate, improper, and fraudulent conduct in the furnishing of health care services.

The University of California, San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It is the only campus in the 10-campus UC system dedicated exclusively to the health sciences.\,\
Required Qualifications: Bacheloru0027s degree in health care or related field and / or minimum three to five years of equivalent experience / training in a hospital revenue cycle setting


Minimum five years of progressive experience in Hospital production coding and/or conducting coding and billing compliance audits

Expert knowledge of ICD-10 and CPT/HCPCS coding guidelines/conventions and applying in varied clinical settings (i.e. hospital, ED, clinic, etc.) and/or multi-specialty areas

Knowledge of Medicare and Medicaid program rules and regulations and experience applying to coding and billing of hospital services

Experience researching, interpreting and comprehending federal and state rules and regulations applicable to clinical documentation and corresponding revenue cycle compliance requirements

Ability to adhere to defined clinical compliance program policies and standards including timely completion of assigned reviews and projects

Increases attention and focus to complete several tasks simultaneously with ability to promptly transition from one task to another, as needed

Excellent interpersonal (i.e. verbal and written communications) and problem solving skills and ability to work collaboratively with all levels of University personnel

Applies thorough ethics and compliance concepts and applications in the completion of assignments. Skills in problem-solving

Ability to gather, organize, complete analysis and develop recommendations in the completion of assignments

Ability to function independently and collaborate effectively with unit team members. Skills in coalescing viewpoints and facilitating outcomes in group settings
Preferred Qualifications: Certification in Health Care Compliance (CHC) by Health Care Compliance Association (HCCA)

Experience conducting moderate to complex hospital coding and billing compliance audits including analysis of findings and preparing written reports

Knowledge of various Medicare payment systems and methodologies (e.g., IPPS, OPPS, MPFS)

Understanding of insurance billing and collection practices and requirements, including Medicare and Medicaid (i.e. Medi-Cal)

Experience in an academic and/or trauma level 1 medical center setting

Experience with Epic electronic health record system

Experience with Encoder software (e.g., 3M, EncoderPro) and/or coding and billing audit software (e.g., MDaudit)
License/Certification: RHIA or RHIT or CCS
Equal Employment Opportunity: The University of California San Francisco is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
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