Clinical Senior Compliance Analyst

Clinical Senior Compliance AnalystClinical Enterprise CompFull TimeJob SummaryThis is a fully remote position.The Clinical Senior Compliance Analyst (i.e. Clinical Analyst) reports directly to the Associate Director of Revenue Cycle Compliance within the Office of Healthcare Compliance & Privacy (OHCP). The Clinical Analyst serves as a centralized resource for planning, supporting, and conducting the claims appeal processes related to third party payer and regulatory audits for UCSF Health hospital and professional revenue cycles. The Clinical Analyst evaluates third party payer and regulatory audit outcomes, proposes corrective actions for risk mitigation and works with compliance leadership to ensure implementation. The Clinical Analyst conducts coding and billing audits including evaluation of medical necessity and/or compliance with clinical requirements related to reimbursement. The Clinical Analyst applies extensive clinical knowledge to address regulatory audit findings and denials related to medical necessity and coding/billing, and serves as a clinical subject matter expert for the UCSF Healthcare Compliance Program.The final salary and offer components are subject to additional approvals based on UC policy.Department DescriptionThe University of California San Francisco Healthcare Compliance Program is responsible for implementation of an "effective compliance program," consistent with the U.S. Federal Sentencing Guidelines and guidance of the HHS Office of the Inspector General. The Program is responsible for the promotion of a comprehensive approach to compliance with health care laws, regulations, and policies across the UCSF healthcare enterprise, which includes a leading academic medical center, outpatient clinics, professional services, and clinical schools.Required QualificationsBachelor's degree in healthcare or related field, and/or equivalent combination of experience/training in a hospital or large healthcare system5 or more years of relevant work experience including a minimum of 5 years progressive experience conducting clinical and/or coding and billing compliance audits for Hospital and/or Professional servicesClinical licensure (e.g., RN - Registered Nurse, NP, PA, MBBS)Advanced knowledge of Medicare and Medicaid program rules and regulations and experience applying rules and regulations in order to defend medical necessity and coded and billed services in both hospital and professional settingsStrong knowledge and understanding of revenue cycle compliance and regulatory standards across the healthcare industry or in-depth knowledge within a specialty areaAbility to perform regulatory and industry research and apply complex clinical concepts relevant to clinical reimbursement requirementsAdvanced organizational and project management skills, with the ability to collaborate with stakeholders, prioritize tasks, and see projects through from inception to completion on schedule.Advanced interpersonal skills for collaborating effectively with managers and staff at all levels and across the organization, and with payers as well as representatives of regulatory audit entities.Advanced skills in written and verbal communications, with the ability to convey highly complex technical information, education, and instructions in a clear and concise manner, and to produce high-quality reports, documentation, presentations, and educational materials.In-depth ability to collaborate effectively with clinicians, senior staff, and management across departments, providing advice and counsel on complex regulatory issues of functionality, efficiency, and program development.Strong analytical and critical thinking skills, with the ability to quickly analyze problems, determine the appropriate level of intervention, and develop and apply effective solutions.Strong knowledge of medical records, medical terminology, principles of ICD-10-CM, ICD-10-PCS, and CPT coding.Strong knowledge of medical and surgical procedures and other healthcare practices and trends.Demonstrated ability to track/trend metrics related to appeal and denial processing.Preferred QualificationsOne or more of the following: RHIA, CCS, CCS-P, CPC, CDIP, CCDSExperience with coding and billing audit softwareExperience with Epic electronic health record systemExperience conducting defense audits and writing formal appeal lettersExperience in an academic and/or trauma level 1 medical center settingLicense/CertificationClinical licensure (e.g., RN - Registered Nurse, NP, PA, MBBS)About UCSFThe University of California, San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.Pride ValuesUCSF is a diverse community made of people with many skills and talents. We seek candidates whose work experience or community service has prepared them to contribute to our commitment to professionalism, respect, integrity, diversity and excellence - also known as our PRIDE values.Equal Employment OpportunityThe University of California San Francisco is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status.

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