The Seattle Cancer Care Alliance (SCCA), located in Seattle, Washington, is part of a dynamic collaboration among three organizations known nationally and internationally for their patient care and research: Fred Hutchinson Cancer Research Center, University of Washington, and Seattle Children's. Over the past 25 years, these institutions have worked together to support their mission of adult and pediatric oncology patient care services, research and education.
Our goal, every day, is to turn cancer patients into cancer survivors. Join us and make a difference.
The Integrity/Compliance Analyst performs daily activities required to fulfill the goals, audit work plans, initiatives and duties of the Integrity Program with a specific focus on compliance in the areas of revenue cycle and research billing, coding and documentation.
This role conducts revenue cycle and research billing compliance audits and investigations, analyzes data, prepares reports, and participates in the development and implementation of follow-up education, outreach, and/or other corrective actions. This position also assists in the development of the Annual CBI Audit Work Plan that addresses future and ongoing compliance risks.
Under the direction of the CBI Manager, the CBI Analyst conducts revenue cycle and research billing compliance audits and investigations, analyzes data, prepares reports, and participates in the development and implementation of follow-up education, outreach, and/or other corrective actions.
1. Conduct clinical billing compliance audits and prepare comprehensive, timely and well written audit reports. Ensures accuracy and integrity of audits by adhering to regulatory requirements and internal policies and procedures.
2. Analyze and organize data, highlighting patterns in a clear and distinguishable manner. Applies expert knowledge of billing regulations, coding rules, clinical documentation standards and compliance principles to identify and understand error frequency, patterns and trends.
3. Assist CBI Manager in conducting compliance risk assessments and identifying high risk areas for auditing and process improvement work.
4. Assist CBI Manager in developing the annual Clinical Billing Integrity Audit Work Plan
5. Maintain up to date knowledge of compliance programs, organizational risks, etc., through professional reading, conference and seminar attendance
6. Maintains a working knowledge on CPT, HCPCS, ICD-9, ICD-10 coding rules and the compliance impact on revenue cycle and research billing of claims.
- Bachelor's Degree in a health care related field or Business administration
- Minimum of 3 years experience in auditing, billing and coding operations or compliance
- Extensive knowledge of APC's, ICD-9-CM (diagnosis), CPT and HCPCS coding principles and guidelines
- Excellent oral and written communication skills including the ability to present findings and recommendations effectively
- Demonstrated ability with technical report writing and presentation of data
- Proficiency with electronic medical record systems, databases and related automated systems. CERNER (ORCA), EPIC, COGNOS and Mede-Analytics are a plus.
- Content area expertise in one or more of the following areas: outpatient and/or inpatient coding, health information management, research billing charge capture, medical necessity, utilization management
- Proficiency with MS Office applications (Excel, Word, Outlook, PowerPoint)
- Ability to independently prioritize and organize work efficiently
- Strong critical thinking and data analysis abilities. Demonstrated attention to detail.
- Comprehensive knowledge of federal and state regulations related to documentation, coding and billing
- Certified Professional Coder-Hospital (CPC-H) or Certified Coding Specialist (CCS) and/or
- Registered Health Information Administrator (RHIA) or Technician (RHIT)
- Facility billing experience
Key Skills and Abilities
- Ability to gather information from multiple sources in order to gain a thorough understanding of problems/issues under investigation
- Knowledge of research billing and/or research compliance requirements
- Ability to develop and maintain collaborative working relationships with all departments involved in the audit and investigation process
- Demonstrated proficiency in project management and tools
- Ability to work independently and as a team member.
- Excellent organizational skills
- Knowledge of software tracking mechanisms for compliance issues
- Experience with report generation for analyzing and presenting data
- Ability to collaborate with others in seeking resolutions of problems
- Ability to exercise strict confidentiality with all aspects of the position
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