Description

JOB SUMMARY

The Healthcare Billing Compliance Consultant Sr performs ongoing activities related to the development, implementation, maintenance of, and adherence to established policies and procedures in compliance with federal, state, and local laws and regulations.

ESSENTIAL FUNCTIONS OF THE ROLE

This position will be supporting Hospital and Professional areas of billing compliance:

• Conducts audits and assessments to ensure compliance with BSWH policies and CMS and Texas Medicaid regulations, providing reports, recommendations, and corrective action follow-up. Monitors trends to identify deficiencies and training needs.

• Helps in reviewing reported compliance incidents and complaints applicable to BSWH policies and procedures or federal and state laws. May coordinate investigations through completion and appropriate reporting. Follows through to implement effective corrective actions.

• Manages and develops education and training materials as appropriate; ensures that lessons are completed in a timely way.

• Responds to inquiries and guidance requests utilizing applicable Medicare and Medicaid rules and regulations. Serves as a compliance resource to BSWH departments and entities on compliance matters.

KEY SUCCESS FACTORS

• Continually demonstrates initiative by learning business processes and applicable auditing techniques.

• Ability to exercise good judgment, attention to detail, integrity, dependability, and objectivity.

• Excellent written and oral communication skills based on level of expertise.

• Proficient in Microsoft Word and Excel.

• Demonstrates professional growth by obtaining continuing education and seeking certifications. Certified in Healthcare Compliance (CHC) preferred.

BENEFITS

Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:

• Immediate eligibility for health and welfare benefits

• 401(k) savings plan with dollar-for-dollar match up to 5%

• Tuition Reimbursement

• PTO accrual beginning Day 1

Note: Benefits may vary based on position type and/or level

QUALIFICATIONS

- EDUCATION - Bachelor's or 4 years of work experience above the minimum qualification

- EXPERIENCE - 3 Years of Experience - Billing/Healthcare experience

Hybrid expectation: mostly remote, occasional on-site expectation for events or as needed