Compliance Analyst

The Compliance Analyst provides both analytic support and subject matter expertise ensuring organizational practices adhere to revenue cycle regulations, guidelines and best practices. Supports the fiscal goals of the organization by providing oversight of processes which impact reimbursement, for both internal services and services provided by contracted third-parties. Serves as a resource and facilitator for all areas of enterprise-wide coding and charge-entry operations. Stays current on industry standards. Responsible for updating, communicating and monitoring of a coding and reimbursement compliance plan that supports sound and compliant billing practices by providers and employed and contracted coding personnel.
Develops and Facilities Applicable Compliance Policies and Best Practice Workflows
Oversees coding and documentation integrity policies and standard operating procedures for the organization, whether provided by internal or 3rd party contractors. Ensures revenue integrity through compliant coding and documentation capture approaches. Performs research on best practices and national benchmarks for coding and documentation capture to assist in standardization and performance monitoring.
Monitors and Tracks Compliance Performance
Monitors coding and documentation KPIs and overall trends and implements educational and corrective actions plans for both internal and external resources. Prepares reports for leadership review. Actively manages the coding compliance plan to ensure ongoing oversight and provides ad hoc auditing and QA against compliance policies and best practice. Reports as requested to the compliance committee and/or other committees performance monitoring in support of the compliance plan. Ensures annual audits are scheduled and reported to Finance to support physician PSA annual review. Reviews claim denials and rejections pertaining to coding and medical necessity issues and, when necessary, implements corrective action plan to prevent similar denials and rejections from recurring. Assists billing in processing claims that have failed due to diagnosis and procedure code errors. Collaborates with other subject matter experts to achieve organizational goals.
Additionally in support of compliance monitoring the Compliance Analyst provides initial analysis of Compliance Line submissions, assigns tickets accordingly and assists with investigations as directed by legal counsel.
Oversees Coding Audits
Facilitates coding compliance plan with applicable internal or external auditors and monitors outsource coding contracts. Monitors coding and documentation improvement activities to assure compliance with CMS Coding Guidelines, other regulatory oversight organizations and physician PSA coding and billing requirements. Establishes performance metrics and tracks results; implements corrective action plans as indicated. Serves as Facilitates communication between audit resources and providers. Directs the efforts of the Coding Auditors in their performance of regular audits and coordinates ongoing monitoring of coding and documentation adequacy.
Facilitates Feedback and Training
Facilitates coding and documentation requirements through education and feedback to obtain documentation completeness and appropriately represent the services provided by the Medical and Clinical team members. Works collaboratively with physicians and operational staff to facilitate accurate documentation to support the billing code assignment. Serves as the organizational expert related to coding rules and guidelines. Coordinates educational and training programs regarding elements of coding and coding compliance for appropriate personnel to facilitate proactive, rather than reactive compliance. Also facilitates general regulatory training for providers and staff in support of delegated contracting status.
In collaboration with Director and Compliance Officer, develops the annual coding compliance educational plan. Effectively works with other departments within the organization as well as outsourced partners, finance and compliance.

Supports Value Based Care (VBC) Workstreams Within Organization
Supports the VBC programs in the organization including HCC workstreams. Works with HCC team, operations, and physician leadership to provide regular performance reports. Ensures HCC code submission workstreams, including 3rd party support and ASM data submission are well-defined and followed. Supports other VBC programs as necessary.
Provides Subject Matter Expertise in Supporting Technology
Continually identifies workflow improvements leveraging automation to facilitate timely and accurate documentation, charge entry, coding as well as decrease manual processes when possible. Serves as the Subject Matter Expert (SME) for hospital charge capture software and facilitates physician configuration, vendor engagement and training. Works collaboratively with IT.