Senior Compliance Associate - Hospital Billing

About the role

The Senior Compliance Associate - Hospital Billing reflects the mission, vision, and values of NM, adheres to the organization's Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

The Senior Compliance Associate assists the department managers and directors in the implementation of all aspects of the NMHC Corporate Compliance Program, including leading key initiatives as may be required.

Responsibilities

• Respond to hospital billing compliance inquiries and concerns received through multiple reporting mechanisms, including the Compliance Hotline, by assessing issues, providing guidance, triaging matters to appropriate stakeholders, and maintaining accurate documentation of reports and resolutions.
• Conduct and support compliance investigations, as they relate to hospital billing, by gathering and analyzing relevant information, interviewing stakeholders as appropriate, identifying root causes, documenting findings, and developing recommendations for corrective action and process improvement.
• Lead compliance reviews and associated follow ups related to hospital billing and inpatient services, which may include, assessing billing accuracy, coding compliance, documentation sufficiency, medical necessity, and adherence to state and federal requirements.
• Serve as a coordinator for regulatory inquiries, audits, and investigations, including matters involving CMS, OIG, and other federal and state agencies; assist with medical record review, claim review, quality assurance of clinical documentation and response preparation
• Identify, assess, and monitor healthcare compliance risks across the health system; proactively recognize emerging issues, recommend mitigation strategies, and elevate concerns to leadership for timely resolution
• Maintain a current understanding of regulatory trends and changes in compliance and regulatory guidelines that affect the health system and its subsidiaries by monitoring various resources to assess regulatory changes and determine organizational impact
• Assist with the development and implementation of the department's annual Compliance Work Plan
• Help develop and maintain compliance-related policies and procedures to ensure they are current and relevant. Assist with providing policy-related guidance to individuals and departments
• Coordinate and facilitate agendas and materials for compliance-related committees
• Help develop department and organizational metrics to clearly and efficiently monitor the organization's compliance with various rules and regulations, policies and procedures, etc.
• Perform other duties assigned by the department Manager, Director, or VP, Integrity

Qualifications & Requirements

Required

• Education:
• Bachelor's degree or 6 to 8 years of compliance, clinical or legal experience
• Licensure:
• Certification:
• Certified coder (e.g., RHIA, RHIT, CCS, CCS-P, or equivalent) or eligible
• Experience:
• Healthcare experience related to hospital inpatient services, which may include compliance, regulatory, legal, coding, billing, auditing, or clinical operations
• Proficiency in Microsoft Office applications, including Word, Excel, PowerPoint, Access, and related business software
• Behavioral Attributes:
• Strong written, verbal, and interpersonal skills, with the ability to effectively communicate and collaborate with stakeholders at all levels of the organization
• Demonstrated ability to handle confidential and sensitive information with discretion and professionalism
• Ability to convey complex information in a clear, concise, and professional manner
• Strong organizational, analytical, and problem-solving skills, with the ability to manage multiple priorities in a fast-paced environment

Preferred

• Registered Nurse (RN) with clinical auditing, compliance, utilization review, or nurse auditor experience to perform medical necessity reviews
• Juris Doctor (JD), or related experience interpreting and applying state and federal healthcare regulations
• Certified in Healthcare Compliance (CHC)
• Knowledge of both hospital and professional billing
• Proficiency in Epic and MDAudit

Additional Information

Background Check

If you are offered a position with us, you will be required to complete an authorization and disclosure form that gives Northwestern Medicine permission to run the background check. Results are evaluated on a case-by-case basis, and we follow all local, state, and federal laws, including the Illinois Health Care Worker Background Check Act.

Artificial Intelligence Disclosure

Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person.

Benefits

• We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events.
• Please refer to the Benefits Eligibility by Employment Classification to determine benefits eligibility for job postings.

If sign-on bonus is included in a job posting eligibility is as followed: Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign-on bonus. Exception: New graduate internal employees seeking their first licensed clinical position as a Registered Nurse at NM may be eligible.