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Senior Analyst, Clinical & Billing Investigations (Denver, CO)
Title: Senior Analyst, Clinical & Billing Investigations @ Denver, CO
Terms of Hire: Full time.
GENERAL PURPOSE OF THE JOB:
This position reports to the Senior Manager, Clinical Documentation and Billing Investigations and will apply their experience with investigations, audits, and/or consulting projects to identify and evaluate compliance and regulatory risks associated with potential non-compliance with Company policies, procedures, and practices. Generally, this position assists in the execution of the day-to-day compliance program for our dialysis business unit, specifically the Information Technology (IT), Clinical Enterprise, and Revenue Operations departments. The position, amongst other responsibilities outlined below, will investigate potential compliance issues linked to clinical and billing activities, including clinical IT systems.
The job responsibilities of the Healthcare Compliance Senior Analyst, Clinical and Billing Investigations include, but are not limited to the following, with a goal of mitigating risk related to the False Claims Act and other state and federal regulations:
Terms of Hire: Full time.
GENERAL PURPOSE OF THE JOB:
This position reports to the Senior Manager, Clinical Documentation and Billing Investigations and will apply their experience with investigations, audits, and/or consulting projects to identify and evaluate compliance and regulatory risks associated with potential non-compliance with Company policies, procedures, and practices. Generally, this position assists in the execution of the day-to-day compliance program for our dialysis business unit, specifically the Information Technology (IT), Clinical Enterprise, and Revenue Operations departments. The position, amongst other responsibilities outlined below, will investigate potential compliance issues linked to clinical and billing activities, including clinical IT systems.
The job responsibilities of the Healthcare Compliance Senior Analyst, Clinical and Billing Investigations include, but are not limited to the following, with a goal of mitigating risk related to the False Claims Act and other state and federal regulations:
- Investigate potential compliance issues linked to clinical and billing activities, including clinical IT systems.
- Conduct IT system investigations and audits including performing risk assessment, scoping investigation/audit, developing investigation/audit work plans, performing investigation/audit procedures, documenting work, reporting findings, and developing and implementing appropriate remediation.
- Perform proactive process and control assessments of policies, procedures, and clinical IT systems.
- Define and understand potential compliance issues, collect, and analyze large amounts of data, perform research, identify root causes of potential issues, and evaluate risk to make timely and appropriate decisions.
- Utilize Excel, Access, and other tools to perform qualitative and quantitative analyses on large amounts of clinical and billing data and develop presentations to communicate the results of such analyses to compliance and operations management.
- Conduct multiple projects concurrently while managing timelines with their manager and internal customers and assist their manager with projects related to the overall compliance audit and monitoring Programs.
- Draft written presentations to compliance and operations management to inform decision making; and
- No direct reports.
- Bachelor’s degree required; JD/CPA/CIA/MBA or other relevant advanced degree or certification preferred.
- Certificate in Healthcare Compliance preferred.
- Minimum of 3 years’ experience as an investigative, audit, compliance, or legal professional responsible for compliance investigations, external/internal audits, and consulting projects (e.g., process and control assessments).
- Required experience working with Medicare Fee for Service claims and respective electronic health record and billing IT systems.
- Preferred experience working for Big 4 or mid-sized audit firms, other consulting firms, or a healthcare company.
- Preferred experience in healthcare industry dealing with federal healthcare program laws, specifically the False Claims Act.
- Preferred experience working with Medicare Fee for Service regulations including CMS Conditions for Coverage (CfC), Conditions for Participation (CfP), and other CMS Manuals.
- Strong organizational and project management skills with demonstrated attention to detail.
- Experience in positively and successfully managing relationships with a high energy and diverse group of internal customers across organizational lines.
- Advanced technology skills including Excel, PowerPoint, and Access including experience with using these tools to create data analytics (e.g., Pivot Table, Vlookup, etc.).
- A thoughtful, articulate, and effective critical thinker and communicator who can distill and articulate the important aspects of any issue.
- Superior written and verbal communication skills (including presentations) and the ability to drive execution in a team environment.
- Must be self-motivated, team player with proven ability to identify issues, manage priorities, and deliver on commitments in a fast-paced environment; and
- Hands on, efficient and proven ability to “Get Stuff Done” with a bias for action and a strong sense of ownership.
- Limited travel required: up to 10%
- An opportunity to be a part of a great culture, an awesome team, a challenging work environment, and some fun along the way!
- Apply today to learn more and be part of our Growth story.
Department: Scout
This is a full time position