Senior Compliance Coding Analyst - Business Practices (Medical Center)

Overview

At Houston Methodist, the Sr Compliance Coding Analyst position is responsible for supporting accurate billing and coding compliance with Medicare and third-party payments and internal policies. Responsibilities for this position include serving as subject matter expert, performing complex and high risk-based and baseline compliance reviews, and identifying potential risk areas and revenue potential. The Sr Compliance Coding Analyst position partners with stakeholders to provide feedback regarding documentation and billing practices to identify potential risk and identify and capture potential revenue opportunities. This position performs quality assurance, detailed claims analysis, and medical record reviews of complex claims and records and serves as a mentor to more junior team members, assisting with onboarding and training as needed.

Houston Methodist Standard

PATIENT AGE GROUP(S) AND POPULATION(S) SERVEDRefer to departmental "Scope of Service" and "Provision of Care" plans, as applicable, for description of primary age groups and populations served by this job for the respective HM entity.

HOUSTON METHODIST EXPERIENCE EXPECTATIONS

• Provide personalized care and service by consistently demonstrating our I CARE values:
  • INTEGRITY: We are honest and ethical in all we say and do.
  • COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
  • ACCOUNTABILITY: We hold ourselves accountable for all our actions.
  • RESPECT: We treat every individual as a person of worth, dignity, and value.
  • EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.

• Practices the Caring and Serving Model

• Delivers personalized service using HM Service Standards

• Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)

• Intentionally collaborates with other healthcare professionals involved in patients/customers or employees' experiential journeys to ensure strong communication, ease of access to information, and a seamless experience

• Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job

• Actively supports the organization's vision, fulfills the mission and abides by the I CARE values

Responsibilities

PEOPLE ESSENTIAL FUNCTIONS

• Collaborates with revenue integrity teams to review provider services and provide effective education and feedback. Coordinates revenue cycle physician feedback meetings and other meetings as needed.

• Effectively and proactively communicates with all stakeholders to resolve issues and discrepancies in a timely manner.

• Actively participates in meeting and huddles using positive communication and makes positive contributions that contribute to department success. Mentors more junior team members and supports the training and onboarding of new staff.

SERVICE ESSENTIAL FUNCTIONS

• Conducts risk-based and baseline reviews of complex and escalated claims or records in a timely manner, evaluates corrective actions and processes applicable refunds within established timeframes of communication to provider and/or department.

• Coordinates with appropriate stakeholders to provide feedback regarding documentation and billing practices as well as potential risk areas with electronic medical record.

• Provides periodic status reports of risk-based audit outcomes. Provides education as appropriate regarding department specific practices. Serves a subject matter expert.

• Effectively communicates audit results to faculty and staff.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• Performs billing compliance reviews that meet department quality standards.

• Interprets and communicates potential revenue loss associated with incorrect coding or application of coding guidelines.

• Identifies potential risk areas and/or revenue potential through audit process. Communicates information to faculty, staff and residents through newsletters or webinars.

FINANCE ESSENTIAL FUNCTIONS

• Utilizes resources effectively and efficiently, demonstrating responsible financial stewardship. Manages own time effectively and prioritizes work to achieve maximum results in a timely manner.

• Identifies, prioritizes and conducts reviews based on data analytics. Coordinates with appropriate stakeholders to identify and capture potential revenue opportunities.

• Verifies that accurate and concise claims are being billed t