Compliance Analyst 3 - Provider Billing and Coding

WHY UT SOUTHWESTERN?
With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the No. 1 hospital in Dallas-Fort Worth according to U.S. News & World Report, we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you'll discover a culture of teamwork, professionalism, and a rewarding career! 

JOB SUMMARY
Works under minimal supervision to manage and perform compliance assurance/effectiveness reviews of various functions and activities of UT Southwestern. Conducts complex assurance activities to determine departmental/unit/program adherence to internal controls, education/training requirements and compliance with established policies and procedures. 

The 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. Evaluates provider billing practices for compliance with applicable federal and state requirements, payer requirements, and institutional policies and procedures. Performs 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. Analyzes claims, coding, reimbursement, and other data to identify trends, outliers, potential overpayments, and emerging compliance risks requiring further investigation or monitoring.

This position is under a hybrid work schedule with two days per week in office and as needed.

BENEFITS
UT 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 EDUCATION

Required

• 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.

Knowledge, Skills and Abilities

• Work requires ability to evaluate data and determine compliance with rules and regulations
• Work requires excellent written and verbal communications skills.
• Work requires project management skills, including the establishment of goals, objectives while meeting project deadlines.
• Work requires skill in using spreadsheet applications, word processing, and database computer applications.

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

Physical Requirements

• Talking

Working Conditions

• Office Setting

Salary Information
Salary is commensurate with education, skills, and relevant experience.

SECURITY AND EEO STATEMENT

Security
This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.

EEO
UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.
 

WHY UT SOUTHWESTERN?
With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the No. 1 hospital in Dallas-Fort Worth according to U.S. News & World Report, we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you'll discover a culture of teamwork, professionalism, and a rewarding career! 

JOB SUMMARY
Works under minimal supervision to manage and perform compliance assurance/effectiveness reviews of various functions and activities of UT Southwestern. Conducts complex assurance activities to determine departmental/unit/program adherence to internal controls, education/training requirements and compliance with established policies and procedures. 

The 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. Evaluates provider billing practices for compliance with applicable federal and state requirements, payer requirements, and institutional policies and procedures. Performs 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. Analyzes claims, coding, reimbursement, and other data to identify trends, outliers, potential overpayments, and emerging compliance risks requiring further investigation or monitoring.

This position is under a hybrid work schedule with two days per week in office and as needed.

BENEFITS
UT 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 EDUCATION

Required

• 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.

Knowledge, Skills and Abilities

• Work requires ability to evaluate data and determine compliance with rules and regulations
• Work requires excellent written and verbal communications skills.
• Work requires project management skills, including the establishment of goals, objectives while meeting project deadlines.
• Work requires skill in using spreadsheet applications, word processing, and database computer applications.

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

Physical Requirements

• Talking

Working Conditions

• Office Setting

Salary Information
Salary is commensurate with education, skills, and relevant experience.

SECURITY AND EEO STATEMENT

Security
This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.

EEO
UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.