Regulatory Compliance Specialist-Medicare Analyst

4 days ago

Houston, United States Houston Methodist Full time

***Medicare compliance experience is preferred Note: Office for this position is located at our Continuing Care Hospital:

701 S. Fry Rd. Katy, TX 77450

. (Hybrid position) At Houston Methodist, the CBO Regulatory Compliance Specialist position is responsible for working with Houston Methodist's Corporate Central Business Office (CBO) leadership, to assess, track, monitor, document progress and status of management action plans and maintain completion of compliance recommendations set forth by audits from Center for Medicare/Medicaid Services (CMS), other applicable regulatory agencies, and/or Houston Methodist Internal Audit compliance reviews. This position audits sources include but are not limited to CMS, OIG, RACs, MACs, ADRs, TPEs, CERTs, Z/UPICS, along with Houston Methodist Internal Audit recommendations. Responsibilities for this position included working with the applicable staff from Corporate Finance, Revenue Cycle, Business Practice, Ancillary Service Areas, CBO Staff, and/or Internal Audit to document closure of action items related to defined audit events as well as the accountability of ensuring completion with corrected claims, and/or data extraction in preparation of audits.

PEOPLE ESSENTIAL FUNCTIONS Collaborates and effectively communicates with a wide variety of disciplines with the organization and revenue cycle to assist in evaluating, monitoring, documenting, and trending completion of recommendations or findings. Provides clear and concise communication of trending and findings to CBO leadership. Maintains a strong sensitivity to customer needs at the forefront of CMS Audit or internal regulatory projects/efforts/needs by ensuring timely and complete compliance with customer requests. Consistently executes in appropriately balanced behavior that support I CARE values. Communicates in a time efficient and effective manner.

SERVICE ESSENTIAL FUNCTIONS Responsible for coordination and provision of ongoing support and assistance to CBO leadership regarding completion of audit findings and recommendations. Assists as needed in initial and/or subsequent data captures and requests for regulatory or internal audits and ensures to transmit with appropriate HIPAA standards for PHI. Provides subsequent follow up reviews of previously identified issues and/or requests that result from audit events and ensures the action item is complete. Acts as a liaison between the customer and the CBO team to ensure timely compliance with and completion of audit or data requests.

QUALITY/SAFETY ESSENTIAL FUNCTIONS Assists management in developing internal quality measures to evaluate, improve and sustain performance improvement initiatives while serving as a resource for these efforts. This can include but is not limited to assisting in re-educating staff as needed, updating policies and procedures relative to audit findings and recommendations as indicated by management. Responsible for ensuring that non-conformities identified during the audit process have complete resolution by providing follow up activities and documentation of the same. Provides technical assistance to management and functions as subject matter expert for compliant billing for government payers.

FINANCE ESSENTIAL FUNCTIONS Assists management as needed to implement audit findings to reduce compliance errors, avoidable denials, recoupments, and losses. Assists management in finalizing quarterly credit balance report to Medicare. Practices good time management, good assessment in professional decision-making, and reporting skills which includes managing self to ensure project deliverables are met.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS Maintains current knowledge of applicable state and federal regulations, CMS regulation, and billing requirements Remains current with regulatory changes by utilizing available educational tools and by reviewing professional journals, as well as communicating changes or newly developed standards, requirements, and clauses to appropriate staff, departments and leadership, as indicated. Effectively uses technology tools to execute job functions and accomplish duties which includes Microsoft Office Suite, Change Healthcare products, Epic, etc. Continues personal development to ensure balanced execution of functions technically and behaviorally.

This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.

EDUCATION High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.) Some college preferred

WORK EXPERIENCE Five years' experience in revenue cycle in a hospital setting Demonstrated application of government billing and collections Government billing and collections experience in a hospital setting Epic experience in HB preferred

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