"Alerted.org

As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.

Job Location (Full Address):

175 Corporate Woods, Rochester, New York, United States of America, 14623

Opening:

Worker Subtype:

Regular

Time Type:

Full time

Scheduled Weekly Hours:

40

Department:

900017 Compliance Office

Work Shift:

UR - Day (United States of America)

Range:

UR URG 111

Compensation Range:

$63,815.00 - $95,723.00

_The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations._

Responsibilities:

GENERAL PURPOSE

The Compliance Analyst II conducts investigations, risk assessments, and regulatory monitoring to prevent and detect fraud, waste, and abuse, specifically addressing the DRA, NY SSL § 363-d, and 18 NYCRR SubPart 521. Requires a high degree of accuracy, professional judgment, and accountability, as errors can result in significant regulatory or financial penalties or reputational risk.

There are two pathways for the Compliance Analyst II (1: Compliance Billing, Coding, and Education Analyst,** **or** **2: Compliance Specialist):

1: Compliance Billing, Coding, and Education Analyst

Provides compliance oversight and support for assigned clinical specialties across URMC and Affiliates in accordance with the OIG and OMIG compliance program guidance. Evaluates adherence to coding and billing regulations and guidelines through review, research, and analysis. Serves as a compliance resource, developing and delivering comprehensive education and training.

2: Compliance Specialist

Provides compliance oversight and support across URMC and Affiliates in accordance with OIG and OMIG compliance program guidance. Evaluates adherence to regulations, laws, and guidelines through review, research, and analysis. Serves as a compliance resource, developing and delivering comprehensive education and training.

Compliance Analyst II General Responsibilities:

+ Responds to reported compliance concerns by conducting formal investigative activities. Assesses and documents allegations of non-compliance in the department’s case management system

+ Performs root cause analysis when deficiencies are identified. Collaborates with relevant stakeholders to determine improvement opportunities to mitigate future risk. Collaborates with OIC leadership to determine corrective action, such as formal self-disclosures or claim adjustments

+ Assists in responding to external audits and government investigations as directed.

+ Participates in special projects and investigations as directed by compliance leadership and/or Office of Counsel.

+ Maintains up-to-date knowledge of compliance risks by engaging in professional associations, networking with peers at other academic medical centers, reviewing relevant literature, and participating in industry seminars and educational events.

+ Performs other duties as assigned

1: Compliance Billing, Coding, and Education Analyst Responsibilities

+ Analyzes billing data to identify potential risk areas related to professional and/or facility payment systems.

+ Performs audits of medical record documentation to ensure compliance with coding and billing requirements as defined by AMA, AHA, HCPCS, CMS, and Medicaid guidelines.

+ Creates and provides reports on findings to relevant stakeholders

+ Plans and strategizes each investigation, collects and analyzes documents, data, electronic records, billing and clinical documentation, and other relevant materials. Conducts interviews with reporters, witnesses, and implicated individuals. Reviews facts in the context of applicable coding, billing, and regulatory requirements.

+ Develops and delivers comprehensive education and training sessions for faculty, residents, and staff, covering essential topics such as coding, compliance with Medicare, Medicaid, and third-party payer billing regulations, and fraud, waste, and abuse prevention.

+ Serves as a resource and subject matter expert for URMC and Affiliate personnel, offering guidance on billing, coding, and reimbursement matters

+ Assists in due diligence activities related to physician practice and provider acquisitions as directed by OIC leadership and/or Office of Counsel.

2: Compliance Specialist

+ Plans and strategizes each investigation, collects and analyzes documents, data, electronic records, and other relevant materials. Conducts interviews with reporters, witnesses, and implicated individuals. Reviews facts in the context of applicable regulatory requirements

+ Coordinates and conducts risk assessments and audits for compliance categories, including, but not limited to, effective compliance program elements and governance, payments (grants, waivers, financial statements, billing), credentialing, privileging, Stark Law, Anti-Kickback Statute, exclusions, Conflict of Interest, and vendor/contractor ethical relationships.

+ Creates and provides reports on findings to relevant stakeholders.

+ Serves as a resource to URMC and Affiliates by researching and interpreting healthcare regulations.

+ Creates, updates, and provides OMIG mandatory educational content and training for affected individuals on relevant compliance topics.

+ Creates, reviews, and updates compliance program policies and procedures

+ Assists with compliance committee and board meeting preparation at the direction of the compliance leadership

Qualifications:

1.** **Compliance Billing, Coding, & Education Analyst

+ **Minimum Education** - Bachelor’s degree in a related field. Equivalent combination of education, professional certification(s), and substantial relevant experience will also be considered

+ Experience **–** Minimum of **3 years of healthcare coding experience** required, to include: **APG** , **APC** , and/or **DRG** coding methodologies or professional coding and billing in specialty areas.

+ Experience in a direct or supporting role within healthcare compliance, preferably within an integrated health system, an Academic Medical Center, or other comparable setting preferred.

+ **Certifications**

+ One of the following credentials is preferred:

+ Registered Health Information Technologist ( **RHIT** ),

+ Registered Health Informational Administrator ( **RHIA** ),

+ Certified Coding Specialist ( **CCS** or **CCS-P** ),

+ Certified Professional Coder ( **CPC** ), Certified Outpatient Coder ( **COC** ), or equivalent professional certification.

+ Certified in Healthcare Compliance ( **CHC** )

2. Compliance Specialist

+ **Minimum Education** - Bachelor’s degree in a related field. Equivalent combination of education, professional certification(s), and substantial relevant experience will also be considered

+ Experience **–** Minimum of **3 years of experience in a direct or indirect healthcare compliance role in an integrated health system or a comparable healthcare setting.**

+ **Certifications**

+ One of the following credentials is preferred:

+ Certified in Healthcare Compliance (CHC),

+ Certified Compliance & Ethics Professional (CCEP),

+ Certified Fraud Examiner (CFE),

+ Certified Internal Auditor (CIA),

+ Or equivalent professional certification

Knowledge, Skills & Abilities

+ Strong communication, interpersonal, and public speaking skills.

+ Ability to efficiently produce clear, concise, and complete written audit reports.

+ Excellent analytical, organizational, and problem-solving skills.

+ Demonstrated objectivity and critical thinking in analyzing situations; must be able to evaluate facts without bias and avoid unsupported assumptions.

+ Ability to manage projects and effectively advise staff in a motivational and positive manner.

+ Willingness to collaborate with others and to work as part of a team.

+ Ability to maintain high discretion and confidentiality with sensitive information.

+ Experience creating, editing, and manipulating data and documents using Microsoft Office.

+ Ability to effectively use compliance monitoring and documentation systems.

The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University’s Mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.

Notice: If you are a **Current** **Employee,** please **log into myURHR** to search for and apply to jobs using the Jobs Hub. Your application, if submitted using this portal, cannot be moved forward.

Learn. Discover. Heal. Create.

Located in western New York, Rochester is our namesake and our home. One of the world’s leading research universities, Rochester has a long tradition of breaking boundaries—always pushing and questioning, learning and unlearning. We transform ideas into enterprises that create value and make the world ever better.

If you’re looking for a career in higher education or health care, the University of Rochester may offer the perfect opportunity for your background and goals

At the University of Rochester, we are committed to fostering, cultivating, and preserving an inclusive and welcoming culture and are united by a strong commitment to be ever better—Meliora. It is an ideal that informs our shared mission to ensure all members of our community feel safe, respected, included, and valued.