HCA Healthcare
Regulatory Compliance Senior Consultant
HCA Healthcare, Nashville, Tennessee, United States, 37247
Overview
Join to apply for the
Regulatory Compliance Senior Consultant
role at
HCA Healthcare . Job Summary
As a Billing/Coding Senior Consultant on the Regulatory Compliance team, you will collaborate with facilities/entities within the Company to evaluate and provide billing and coding support, focusing on areas where significant data discrepancies are identified. Your primary responsibility will be to research, evaluate, and proactively identify outliers related to billing and coding information, based on established coding and billing guidelines. The ideal candidate will possess extensive billing and coding experience related to both inpatient and outpatient services. Furthermore, you should be adept at reviewing and communicating current and anticipated future regulatory provisions related to billing and coding, with the ability to convey technical requirements clearly to individuals without specialized expertise. Major Responsibilities
Identify significant outliers and collaborate with facilities/entities to evaluate and document the underlying causes. Direct and follow up on corrective actions as necessary to resolve identified issues. Provide comprehensive education and support regarding billing, coding, and regulatory changes to ensure compliance. Support and/or lead special projects, offering expertise from a coding and billing compliance perspective. Serve as a valuable resource for Corporate, Hospital, and Parallon colleagues, offering guidance and support. Demonstrate leadership through innovation, knowledge sharing, and best practices when collaborating with customers and peers. Apply in-depth knowledge of billing and coding guidelines, coupled with effective communication and listening skills, to address complex issues. Proactively assist the Company by evaluating key risk areas, such as PEPPER reports and industry/internal data analytics, and providing expert review of technical billing and technical requirements. Perform detailed data analysis using both Company and industry data to identify trends and potential areas of concern. Evaluate payer-specific coding guidelines and/or policies upon request, ensuring accurate and compliant billing practices. Conduct thorough research, evaluation, and proactive identification of outliers related to billing and coding information to ensure accuracy and compliance. Evaluate and document the root causes of identified outliers, providing clear and concise explanations. Follow up on corrective actions as needed, ensuring timely resolution of issues and preventing recurrence. Provide comprehensive education and assistance regarding billing, coding, and regulatory changes, keeping colleagues informed and compliant. Support and/or lead special projects from a coding and billing compliance perspective, offering expertise and guidance. Serve as a valuable resource for colleagues, providing support and guidance on complex billing and coding matters. Education & Experience
Minimum of seven (7) years’ experience in hospital coding, revenue cycle, or other related healthcare experience required, demonstrating a deep understanding of the healthcare industry. Experience in a leadership role. Preferred Bachelor's degree or equivalent combination of education and/or experience, providing flexibility for candidates with diverse backgrounds. Solid background in billing and coding practices, with a strong understanding of industry standards. Comprehensive knowledge of billing and coding guidelines and regulations, ensuring compliance with legal requirements. In-depth understanding of hospital/coding operations, workflows, and billing/revenue cycle processes, facilitating efficient and accurate billing practices. Licenses, Certifications & Training
Healthcare Billing Training Registered Health Information Technician/Administrator certification Preferred Certified Coding Specialist (CCS) certification Preferred Health Care Compliance Association (HCCA) certification Preferred Certified Compliance & Ethics Professional (CCEP) or similar certification preferred. Additional Information
This role will require up to 25% of travel. We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
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Join to apply for the
Regulatory Compliance Senior Consultant
role at
HCA Healthcare . Job Summary
As a Billing/Coding Senior Consultant on the Regulatory Compliance team, you will collaborate with facilities/entities within the Company to evaluate and provide billing and coding support, focusing on areas where significant data discrepancies are identified. Your primary responsibility will be to research, evaluate, and proactively identify outliers related to billing and coding information, based on established coding and billing guidelines. The ideal candidate will possess extensive billing and coding experience related to both inpatient and outpatient services. Furthermore, you should be adept at reviewing and communicating current and anticipated future regulatory provisions related to billing and coding, with the ability to convey technical requirements clearly to individuals without specialized expertise. Major Responsibilities
Identify significant outliers and collaborate with facilities/entities to evaluate and document the underlying causes. Direct and follow up on corrective actions as necessary to resolve identified issues. Provide comprehensive education and support regarding billing, coding, and regulatory changes to ensure compliance. Support and/or lead special projects, offering expertise from a coding and billing compliance perspective. Serve as a valuable resource for Corporate, Hospital, and Parallon colleagues, offering guidance and support. Demonstrate leadership through innovation, knowledge sharing, and best practices when collaborating with customers and peers. Apply in-depth knowledge of billing and coding guidelines, coupled with effective communication and listening skills, to address complex issues. Proactively assist the Company by evaluating key risk areas, such as PEPPER reports and industry/internal data analytics, and providing expert review of technical billing and technical requirements. Perform detailed data analysis using both Company and industry data to identify trends and potential areas of concern. Evaluate payer-specific coding guidelines and/or policies upon request, ensuring accurate and compliant billing practices. Conduct thorough research, evaluation, and proactive identification of outliers related to billing and coding information to ensure accuracy and compliance. Evaluate and document the root causes of identified outliers, providing clear and concise explanations. Follow up on corrective actions as needed, ensuring timely resolution of issues and preventing recurrence. Provide comprehensive education and assistance regarding billing, coding, and regulatory changes, keeping colleagues informed and compliant. Support and/or lead special projects from a coding and billing compliance perspective, offering expertise and guidance. Serve as a valuable resource for colleagues, providing support and guidance on complex billing and coding matters. Education & Experience
Minimum of seven (7) years’ experience in hospital coding, revenue cycle, or other related healthcare experience required, demonstrating a deep understanding of the healthcare industry. Experience in a leadership role. Preferred Bachelor's degree or equivalent combination of education and/or experience, providing flexibility for candidates with diverse backgrounds. Solid background in billing and coding practices, with a strong understanding of industry standards. Comprehensive knowledge of billing and coding guidelines and regulations, ensuring compliance with legal requirements. In-depth understanding of hospital/coding operations, workflows, and billing/revenue cycle processes, facilitating efficient and accurate billing practices. Licenses, Certifications & Training
Healthcare Billing Training Registered Health Information Technician/Administrator certification Preferred Certified Coding Specialist (CCS) certification Preferred Health Care Compliance Association (HCCA) certification Preferred Certified Compliance & Ethics Professional (CCEP) or similar certification preferred. Additional Information
This role will require up to 25% of travel. We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
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