Compliance Analyst II

• Provides compliance oversight and support for assigned clinical specialties across URMC and Affiliates in accordance with the OIG and OMIG compliance program guidance
• Evaluates adherence to coding and billing regulations and guidelines through review, research, and analysis
• Serves as a compliance resource, developing and delivering comprehensive education and training
• Conducts investigations, risk assessments, and regulatory monitoring to prevent and detect fraud, waste, and abuse, specifically addressing the DRA, NY SSL § 363-d, and 18 NYCRR SubPart 521
• Analyzes billing data to identify potential risk areas related to professional and/or facility payment systems
• Performs audits of medical record documentation to ensure compliance with coding and billing requirements as defined by AMA, AHA, HCPCS, CMS and Medicaid guidelines
• Creates and provides reports on findings to relevant stakeholders
• Responds to reported compliance concerns by conducting formal investigative activities
• Performs root cause analysis when deficiencies are identified
• Collaborates with relevant stakeholders to determine improvement opportunities to mitigate future risk
• Develops and delivers comprehensive education and training sessions for faculty, residents, and staff
• Serves as a resource and subject matter expert for URMC and Affiliate personnel, offering guidance on billing, coding, and reimbursement matters
• Assists in due diligence activities related to physician practice and provider acquisitions
• Assists in assessing and responding to external audits and government investigations
• Participates in special projects and investigations as directed by compliance leadership and/or Office of Counsel
• Maintains up-to-date knowledge of compliance risks by engaging in professional associations, networking with peers at other academic medical centers, reviewing relevant literature, and participating in industry seminars and educational events
• Performs other duties as assigned

• Bachelor or Associate’s degree in a related field preferred
• Equivalent combination of education, professional certification(s), and substantial relevant experience will also be considered
• Minimum of 3 years of healthcare coding experience required to include APG, APC, and/or DRG coding methodologies or professional coding and billing in specialty areas
• Experience in a direct or supporting role within healthcare compliance preferably within an integrated health system or Academic Medical Center or other comparable setting
• Strong communication, interpersonal, and public speaking skills required
• Ability to efficiently produce clear, concise, and complete written audit reports required
• Excellent analytical, organizational, and problem-solving skills required
• Demonstrated objectivity and critical thinking in analyzing situations
• must be able to evaluate facts without bias and avoid unsupported assumptions required
• Ability to manage projects and effectively advise staff in a motivational and positive manner required
• Willingness to collaborate with others and to work as part of a team required
• Ability to maintain high discretion and confidentiality with sensitive information required
• Experience creating, editing, and manipulating data and documents using Microsoft Office required
• One of the following credentials are required: Registered Health Information Technologist (RHIT), Registered Health Informational Administrator (RHIA), Certified Coding Specialist (CCS or CCS-P), Certified Professional Coder (CPC), or Certified Outpatient Coder (COC) or equivalent professional certification

Certified in Healthcare Compliance (CHC) preferred