Compliance Analyst / UMMS

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Job ID: 55299
Area of Interest: Professionals
Location: Baltimore, MD US
Hours of Work: 8-5
Job Facility: University of Maryland Medical System
Employment Type: Full Time
Shift: DAY
What You Will Do:

The University of Maryland Medical System is a 12-hospital system with academic, community and specialty medical services reaching every part of Maryland and beyond. UMMS is a national and regional referral center for trauma, cancer care, Neurocare, cardiac care, women's and children's health and physical rehabilitation. UMMS is the fourth largest private employer in the Baltimore metropolitan area and one of the top 20 employers in the state of Maryland. No organization will give you the clinical variety, the support, or the opportunities for professional growth that you’ll enjoy as a member of our team. UMMS is currently seeking a Compliance Analyst for our Corporate location.

*** Bachelor’s degree in business administration, healthcare, or a relevant field and 2 years work experience in a business, professional or health care environment, including 1 year experience in a Compliance, Internal Audit, Billing, Coding, Education and Training, Case Investigations, Research or equivalent related fields is REQUIRED***

Under the supervision of the Director of Compliance, the analyst will manage, develop, implement and monitor policies, procedures, processes, training, corrective action plans and overall operations to ensure compliance with federal and state laws and regulations affecting the Medical System and its Affiliates.  Additionally, the Analyst will work collectively with Affiliate management and other personnel to ensure that compliance initiatives are implemented at all UMMS affiliates.  For assigned components, individuals will be responsible for leading efforts implementing, monitoring and tracking Compliance Program elements and providing direction and guidance to affiliate personnel for adherence to industry regulations, system policies, Federal Sentencing Guidelines, CMS Conditions of Participation, Conditions of Payment and State specific requirements. 

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by the individuals assigned to this classification.  These are not to be construed as an exhaustive list of all job duties performed by personnel.

Principal responsibilities of a Corporate Compliance Analyst include:

1. Serves as case investigator and performs follow-up with affiliate personnel on complaints and inquiries received through the Compliance Hotline, internal reporting, or other reporting and monitoring mechanisms.

2. Develops closing summary reports for case investigations and performs follow through to determine implementation of corrective action plans.

3. Serves as a consultant to UMMS operations personnel including Affiliate Compliance Officers for compliance questions and collaborate with affiliate management personnel in the development of corrective action plans.

4. Conducts audits/reviews and performs analysis to determine compliance with applicable federal and state laws, and policies and procedures.

5. Monitors data and trends to determine deficiencies and/or areas for further investigation and provides recommendations.

A.  Billing & Coding

1. Handles Medicare billing and coding issues directly related to Medicare rules and regulations and HSCRC requirements. 

a. Conducts research, data analysis and investigation for billing and coding issues and inquiries.

b. Resolves and responds to billing, coding and risk related inquiries by working collaboratively with Internal
Audit, Hospital Compliance Officers, Rates and Reimbursement and Revenue Cycle teams.

c. Drafts recommendations directly related to billing and coding investigation outcomes.

d. Develops closing summary for all investigated billing and coding issues and inquiries and creates executive summaries for management reporting.

e. Performs statistical and data analysis to identify outlier patterns that require investigation for Affiliates and their functional areas. Provides oversight for monitoring, review, investigation and resolution of any confirmed outlier event.

f. Analyzes external audit activity to capture consistent data on topics, prepare reports for Executive Compliance Committee, the Affiliate Compliance Officer Committees and other meetings as requested, and analyze if internal follow-up required at other Affiliates based on topics.

B. Compliance Program Metrics

1. Manages validation of Compliance Program Metrics, identifies gaps and develops and reports aggregated data by Affiliate. Develops management and committee reports based on aggregated System data.

a. Collects documentation from Hospital Compliance Officers quarterly and annually regarding their Compliance Program Metrics and assists in determining documentation is appropriate, reviews for statistical accuracy, meets standards, requests more information if required, and ensures it is complete.

b. Works collaboratively with Hospital Compliance Officers in understanding and continually monitoring the metrics, identifying educational gaps and develops process and training tools to close those gaps.

c. Completes required metrics summary chart and highlights overview for management presentation

d. Prepares corporate compliance summaries of project research into electronic formats for meetings and presentations

e. Validates data as requested and makes recommendations to improve the accuracy of the data. Presents ideas for modifications and additions to the metrics to make the Compliance Program more robust or measure compliance outcomes.

Employee Benefits

As a University of Maryland Medical System (UMMS) employee, you will enjoy a comprehensive benefits program designed with you and your dependents in mind. Subject to any eligibility waiting period, all of the benefits are available to regular full-time employees and most benefits are available to regular part-time employees who are regularly scheduled to work twenty (20) or more hours per week. Many benefits are provided at no cost to employees. For others, the cost is shared between UMMS and employees.

What You Need to Be Successful:

Bachelor’s degree in business administration or healthcare or a relevant field would be required. 

2 or more years of experience in a business, professional or health care environment, including one year experience in a Compliance, Internal Audit, Billing, Coding, Education and Training, Case Investigations, Research or equivalent related fields is required.

Experience with data analysis tools and techniques are preferred.

Knowledge, Skills and Abilities

1. PC literate with intermediate proficiency in Microsoft Office Suite, Visio, Internet and data analysis tools and techniques. 

2. Effective verbal, written and interpersonal skills to communicate with colleagues, patients and/or visitors to establish strong working relationships.

3. Strong problem solving and decision-making skills.

4. Strong analytical skills.

5. Ability to work in a self-directed team by taking and giving direction and sharing in the responsibility of the team.

We are an Equal Opportunity/Affirmative Action employer.  All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law. 
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