University of California - San Francisco Campus and Health
Clinical Senior Compliance Analyst
University of California - San Francisco Campus and Health, San Francisco, California, United States, 94199
Clinical Senior Compliance Analyst
Clinical Enterprise CompFull Time80595BRJob SummaryThe 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. The Program develops, implements, and enforces University policy related to UCSF clinical operations and supports methods of preventing and detecting inappropriate, improper, and fraudulent conduct in the furnishing of health care services.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. Skills in coaching and mentoring peersAdvanced 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 materialsIn-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 developmentStrong analytical and critical thinking skills, with the ability to quickly analyze problems, determine the appropriate level of intervention, and develop and apply effective solutionsStrong knowledge of medical records, medical terminology, principles of ICD-10-CM, ICD-10-PCS, and CPT codingStrong knowledge of medical and surgical procedures and other healthcare practices and trendsDemonstrated ability to track/trend metrics related to appeal and denial processingPreferred 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. It is the only campus in the 10-campus UC system dedicated exclusively to the health sciences. We bring together the world's leading experts in nearly every area of health. We are home to five Nobel laureates who have advanced the understanding of cancer, neurodegenerative diseases, aging and stem cells.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. In addition to our PRIDE values, UCSF is committed to equity - both in how we deliver care as well as our workforce. We are committed to building a broadly diverse community, nurturing a culture that is welcoming and supportive, and engaging diverse ideas for the provision of culturally competent education, discovery, and patient care. Additional information about UCSF is available at diversity.ucsf.edu. Join us to find a rewarding career contributing to improving healthcare worldwide.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.For the University of California's Affirmative Action Policy, please visit: https://policy.ucop.edu/doc/4010393/ppsm-20For the University of California's Anti Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-DiscriminationOrganizationCampusJob Code and Payroll Title006531 REGL AND CMPLNC HC SPEC 4Job CategoryProfessional (Non-Clinical), Research and ScientificBargaining Unit99 - Policy-Covered (No Bargaining Unit)Employee ClassCareerPercentage100%LocationRemote / TelecommuteShiftEveningsShift Length8 HoursAdditional Shift DetailsMonday - Friday; 8AM - 5PM PST; Remote Work Model
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Clinical Enterprise CompFull Time80595BRJob SummaryThe 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. The Program develops, implements, and enforces University policy related to UCSF clinical operations and supports methods of preventing and detecting inappropriate, improper, and fraudulent conduct in the furnishing of health care services.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. Skills in coaching and mentoring peersAdvanced 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 materialsIn-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 developmentStrong analytical and critical thinking skills, with the ability to quickly analyze problems, determine the appropriate level of intervention, and develop and apply effective solutionsStrong knowledge of medical records, medical terminology, principles of ICD-10-CM, ICD-10-PCS, and CPT codingStrong knowledge of medical and surgical procedures and other healthcare practices and trendsDemonstrated ability to track/trend metrics related to appeal and denial processingPreferred 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. It is the only campus in the 10-campus UC system dedicated exclusively to the health sciences. We bring together the world's leading experts in nearly every area of health. We are home to five Nobel laureates who have advanced the understanding of cancer, neurodegenerative diseases, aging and stem cells.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. In addition to our PRIDE values, UCSF is committed to equity - both in how we deliver care as well as our workforce. We are committed to building a broadly diverse community, nurturing a culture that is welcoming and supportive, and engaging diverse ideas for the provision of culturally competent education, discovery, and patient care. Additional information about UCSF is available at diversity.ucsf.edu. Join us to find a rewarding career contributing to improving healthcare worldwide.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.For the University of California's Affirmative Action Policy, please visit: https://policy.ucop.edu/doc/4010393/ppsm-20For the University of California's Anti Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-DiscriminationOrganizationCampusJob Code and Payroll Title006531 REGL AND CMPLNC HC SPEC 4Job CategoryProfessional (Non-Clinical), Research and ScientificBargaining Unit99 - Policy-Covered (No Bargaining Unit)Employee ClassCareerPercentage100%LocationRemote / TelecommuteShiftEveningsShift Length8 HoursAdditional Shift DetailsMonday - Friday; 8AM - 5PM PST; Remote Work Model
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