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Regulatory Compliance Specialist-Medicare Analyst
4 months ago
Regulatory Compliance Specialist-Medicare Analyst (Hybrid-Katy)
REFER A FRIEND Current Employees Apply BACK Location: HM Continuing Care Hospital - 701 S Fry Road Katy, Texas 77450 Job Ref: 55429 Talent Area: Administrative Job Shift: DAY 1st - Day Job Type: Full-Time Posted Date: April 23, 2024***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.
Requirements:
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
QUALITY/SAFETY ESSENTIAL FUNCTIONS
FINANCE ESSENTIAL FUNCTIONS
GROWTH/INNOVATION ESSENTIAL FUNCTIONS
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.
Qualifications:
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
LICENSES AND CERTIFICATIONS - REQUIRED
N/AKNOWLEDGE, SKILLS, AND ABILITIES
Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles Ability to analyze and solve problems Ability to work independently and interdependently Appreciation of cultural diversity and sensitivity towards target populations Strong interpersonal skills and demonstrated ability to work with multidisciplinary groups and teams Knowledge of CMS payment methodology and billing compliance Knowledge of regulatory requirements as they relate to billing and collections in a hospital setting Knowledge of process improvement tools and techniques Knowledge of MS Office Suite Knowledge of process/performance improvement principles, a plus Knowledge of Lean and Six Sigma tools and methodology, preferred Proven time management skills and ability to meet deadlines