Komen Graduate Training Program UT MDACC
Senior Compliance Analyst - Clinical Research Billing
Komen Graduate Training Program UT MDACC, Houston, Texas, United States, 77246
Senior Compliance Analyst - Clinical Research Billing
The University of Texas MD Anderson Cancer Center in Houston is a leading center for cancer care, research, education and prevention. It was named the nation\'s No. 1 hospital for cancer care in U.S. News & World Report\'s 2025-2026 rankings and is one of the original three comprehensive cancer centers designated by the National Cancer Institute.
Responsibilities
Conduct and direct compliance reviews and analyses to ensure compliance with federal and state regulations, institutional policies and contractual obligations.
Investigations/Special Reviews: Independently conduct focused audits and investigations into information-sensitive areas of suspected billing and reimbursement non-compliance. Collaborate with other departments to obtain required documents and research background information to develop understanding of the area being audited.
Audit clinical research billing: Independently conduct prospective and/or retrospective inpatient and outpatient professional and/or technical documentation audits of the institution\'s clinical research billing. Identify problems, risk factors, and risk areas regarding compliance with applicable federal/state statutes, regulations, and guidelines from regulatory agencies and third-party payors, as well as internal rules and policies.
Assist with identifying billing and reimbursement compliance issues to be audited; prepare audit notifications and arrange on-site audits as appropriate.
Quantify and communicate billing compliance deficiencies; recommend corrective action plans and changes to operational systems to maintain compliance.
Evaluate audits and investigation results; formulate conclusions and recommendations based on evidence; prepare clear, timely written audit reports.
Present findings and recommendations to departments in Audit Findings Discussion Conferences; communicate effectively with physicians, healthcare professionals, administrative staff, and other workforce members.
Assess audit responses from operational areas and determine if additional follow-up audits are required; maintain complete audit files and auditing databases; extract information for compliance reports.
Compliance Education/Outreach: Collaborate with Education & Outreach teams to develop and provide education and training on Billing & Reimbursement Compliance Requirements to the MD Anderson workforce.
General Compliance Program Activities: Maintain knowledge of new rules and revisions (CMS, Medicare Administrative Contractor, etc.) and communicate updates to departments to support compliant practices.
Education and Experience
Required: Bachelor\'s degree.
Preferred: Master\'s degree.
Required: Six years of experience in a compliance-related field or in research, information technology, cybersecurity, healthcare administration and/or general business as an analyst, auditor, or fraud investigator. If the degree is advanced, four years of experience are required. Additional years of related experience may substitute for the degree on a one-to-one basis.
Preferred: Strong understanding of clinical research, familiarity with regulatory guidance and research compliance standards; experience collaborating with Clinical Research Finance and clinical research billing is preferred but not required. Familiarity with CMS or OIG standards is essential. Ability to work independently, adapt to change, and provide clear training to stakeholders.
Other Information
Requisition ID: 176741
Employment Status: Full-Time
Employee Status: Regular
Work Week: Days
Salary range: $88,000 – $132,000
Work Location: Remote
FLSA: exempt (not eligible for overtime)
Fund Type: Hard
This position is an equal opportunity employer and prohibits discrimination on the basis of race, color, religion, sex, national origin, age, disability, veteran status, or any other protected status in accordance with applicable law.
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Responsibilities
Conduct and direct compliance reviews and analyses to ensure compliance with federal and state regulations, institutional policies and contractual obligations.
Investigations/Special Reviews: Independently conduct focused audits and investigations into information-sensitive areas of suspected billing and reimbursement non-compliance. Collaborate with other departments to obtain required documents and research background information to develop understanding of the area being audited.
Audit clinical research billing: Independently conduct prospective and/or retrospective inpatient and outpatient professional and/or technical documentation audits of the institution\'s clinical research billing. Identify problems, risk factors, and risk areas regarding compliance with applicable federal/state statutes, regulations, and guidelines from regulatory agencies and third-party payors, as well as internal rules and policies.
Assist with identifying billing and reimbursement compliance issues to be audited; prepare audit notifications and arrange on-site audits as appropriate.
Quantify and communicate billing compliance deficiencies; recommend corrective action plans and changes to operational systems to maintain compliance.
Evaluate audits and investigation results; formulate conclusions and recommendations based on evidence; prepare clear, timely written audit reports.
Present findings and recommendations to departments in Audit Findings Discussion Conferences; communicate effectively with physicians, healthcare professionals, administrative staff, and other workforce members.
Assess audit responses from operational areas and determine if additional follow-up audits are required; maintain complete audit files and auditing databases; extract information for compliance reports.
Compliance Education/Outreach: Collaborate with Education & Outreach teams to develop and provide education and training on Billing & Reimbursement Compliance Requirements to the MD Anderson workforce.
General Compliance Program Activities: Maintain knowledge of new rules and revisions (CMS, Medicare Administrative Contractor, etc.) and communicate updates to departments to support compliant practices.
Education and Experience
Required: Bachelor\'s degree.
Preferred: Master\'s degree.
Required: Six years of experience in a compliance-related field or in research, information technology, cybersecurity, healthcare administration and/or general business as an analyst, auditor, or fraud investigator. If the degree is advanced, four years of experience are required. Additional years of related experience may substitute for the degree on a one-to-one basis.
Preferred: Strong understanding of clinical research, familiarity with regulatory guidance and research compliance standards; experience collaborating with Clinical Research Finance and clinical research billing is preferred but not required. Familiarity with CMS or OIG standards is essential. Ability to work independently, adapt to change, and provide clear training to stakeholders.
Other Information
Requisition ID: 176741
Employment Status: Full-Time
Employee Status: Regular
Work Week: Days
Salary range: $88,000 – $132,000
Work Location: Remote
FLSA: exempt (not eligible for overtime)
Fund Type: Hard
This position is an equal opportunity employer and prohibits discrimination on the basis of race, color, religion, sex, national origin, age, disability, veteran status, or any other protected status in accordance with applicable law.
#J-18808-Ljbffr