Senior Compliance Associate - Hospital Billing

Senior Compliance Associate - Hospital Billing

Location Chicago, Illinois

Business Unit Northwestern Medicine Corporate

Job REQID 220216

Job Function Compliance/Legal

Shift Day Job (1st)

Type of Employment Full-Time

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The salary range for this position is $47.57 - $64.22 (Hourly Rate)

Placement within the salary range is dependent on several factors such as relevant work experience and internal equity. For positions represented by a labor union, placement within the salary range is guided by the rules outlined in the collective bargaining agreement.

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 visit our Benefits(opens in new window) section located at jobs.nm.org/benefits to learn more.

Northwestern Medicine is powered by a community of colleagues who are purpose-driven and committed to our mission to deliver world-class care. Here, you'll work alongside some of the best clinical talent in the nation leading the way in medical innovation and breakthrough research with Northwestern University Feinberg School of Medicine.

We recognize where you've been, and we support where you're headed. We celebrate diverse perspectives and experiences, which fuel our commitment to equity and culture of service.

Grow your career with comprehensive training and development opportunities, mentorship programs, educational support and student loan repayment.

Create the life you envision for yourself with flexible work options, a Reimbursable Well-Being Fund and a Total Rewards package that support your physical, mental, emotional, and financial well-being.

Make a difference through volunteer opportunities we offer in local communities and drive inclusive change through our workforce-led resource groups.

From discovery to delivery, come help us shape the future of medicine.

Benefits:

$10,000 Tuition Reimbursement per year ($5,700 part-time)

$10,000 Student Loan Repayment ($5,000 part-time)

$1,000 Professional Development per year ($500 part-time)

$250 Wellbeing Fund per year ($125 for part-time)

Matching 401(k)

Excellent medical, dental and vision coverage

Life insurance

Annual Employee Salary Increase and Incentive Bonus

Paid time off and Holiday pay

Description

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

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