Welcome page Returning Candidate? Log back in! Regulatory Compliance Specialist-Medicare Analyst (Hybrid-Katy) Facility HM Continuing Care Hospital Job Locations US-TX-Katy Category Administrative Position Type Full-Time Department HB CBO - Government Shift 1st - Day Overview

***Medicare compliance experience is preferred

 

Note: Office for this position is located at our Continuing Care Hospital: 701 S. Fry Rd. Katy, TX 77450.  (Hybrid position)

 

At Houston Methodist, the CBO Regulatory Compliance Specialist position is responsible for working with Houston Methodist's Corporate Central Business Office (CBO) leadership, to assess, track, monitor, document progress and status of management action plans and maintain completion of compliance recommendations set forth by audits from Center for Medicare/Medicaid Services (CMS), other applicable regulatory agencies, and/or Houston Methodist Internal Audit compliance reviews. This position audits sources include but are not limited to CMS, OIG, RACs, MACs, ADRs, TPEs, CERTs, Z/UPICS, along with Houston Methodist Internal Audit recommendations. Responsibilities for this position included working with the applicable staff from Corporate Finance, Revenue Cycle, Business Practice, Ancillary Service Areas, CBO Staff, and/or Internal Audit to document closure of action items related to defined audit events as well as the accountability of ensuring completion with corrected claims, and/or data extraction in preparation of audits.

Houston Methodist Standard

PATIENT AGE GROUP(S) AND POPULATION(S) SERVED
Refer to departmental "Scope of Service" and "Provision of Care" plans, as applicable, for description of primary age groups and populations served by this job for the respective HM entity.

HOUSTON METHODIST EXPERIENCE EXPECTATIONS

Provide personalized care and service by consistently demonstrating our I CARE values:INTEGRITY: We are honest and ethical in all we say and do.COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.ACCOUNTABILITY: We hold ourselves accountable for all our actions.RESPECT: We treat every individual as a person of worth, dignity, and value.EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.Practices the Caring and Serving ModelDelivers personalized service using HM Service StandardsProvides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)Intentionally collaborates with other healthcare professionals involved in patients/customers or employees' experiential journeys to ensure strong communication, ease of access to information, and a seamless experience.Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given jobDisplays cultural humility, diversity, equity and inclusion principlesActively supports the organization's vision, fulfills the mission and abides by the I CARE values Responsibilities

PEOPLE ESSENTIAL FUNCTIONS

Collaborates and effectively communicates with a wide variety of disciplines with the organization and revenue cycle to assist in evaluating, monitoring, documenting, and trending completion of recommendations or findings.Provides clear and concise communication of trending and findings to CBO leadership.Maintains a strong sensitivity to customer needs at the forefront of CMS Audit or internal regulatory projects/efforts/needs by ensuring timely and complete compliance with customer requests.Consistently executes in appropriately balanced behavior that support I CARE values.Communicates in a time efficient and effective manner.

SERVICE ESSENTIAL FUNCTIONS

Responsible for coordination and provision of ongoing support and assistance to CBO leadership regarding completion of audit findings and recommendations.Assists as needed in initial and/or subsequent data captures and requests for regulatory or internal audits and ensures to transmit with appropriate HIPAA standards for PHI.Provides subsequent follow up reviews of previously identified issues and/or requests that result from audit events and ensures the action item is complete.Acts as a liaison between the customer and the CBO team to ensure timely compliance with and completion of audit or data requests.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

Assists management in developing internal quality measures to evaluate, improve and sustain performance improvement initiatives while serving as a resource for these efforts. This can include but is not limited to assisting in re-educating staff as needed, updating policies and procedures relative to audit findings and recommendations as indicated by management.Responsible for ensuring that non-conformities identified during the audit process have complete resolution by providing follow up activities and documentation of the same.Provides technical assistance to management and functions as subject matter expert for compliant billing for government payers.

FINANCE ESSENTIAL FUNCTIONS

Assists management as needed to implement audit findings to reduce compliance errors, avoidable denials, recoupments, and losses.Assists management in finalizing quarterly credit balance report to Medicare.Practices good time management, good assessment in professional decision-making, and reporting skills which includes managing self to ensure project deliverables are met.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

Maintains current knowledge of applicable state and federal regulations, CMS regulation, and billing requirementsRemains current with regulatory changes by utilizing available educational tools and by reviewing professional journals, as well as communicating changes or newly developed standards, requirements, and clauses to appropriate staff, departments and leadership, as indicated.Effectively uses technology tools to execute job functions and accomplish duties which includes Microsoft Office Suite, Change Healthcare products, Epic, etc.Continues personal development to ensure balanced execution of functions technically and behaviorally.

This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.

Qualifications

EDUCATION

High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)Some college preferred

WORK EXPERIENCE

Five years' experience in revenue cycle in a hospital settingDemonstrated application of government billing and collectionsGovernment billing and collections experience in a hospital settingEpic experience in HB preferred License/Certification

LICENSES AND CERTIFICATIONS - REQUIRED

N/A KSA/ Supplemental Data

KNOWLEDGE, SKILLS, AND ABILITIES

Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluationsSufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or securityAbility to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principlesAbility to analyze and solve problemsAbility to work independently and interdependentlyAppreciation of cultural diversity and sensitivity towards target populationsStrong interpersonal skills and demonstrated ability to work with multidisciplinary groups and teamsKnowledge of CMS payment methodology and billing complianceKnowledge of regulatory requirements as they relate to billing and collections in a hospital settingKnowledge of process improvement tools and techniquesKnowledge of MS Office SuiteKnowledge of process/performance improvement principles, a plusKnowledge of Lean and Six Sigma tools and methodology, preferredProven time management skills and ability to meet deadlines

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

Uniform NoScrubs NoBusiness professional YesOther (department approved) No

ON-CALL*
*Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.

On Call* No

TRAVEL**
**Travel specifications may vary by department**

May require travel within the Houston Metropolitan area YesMay require travel outside Houston Metropolitan area No Company Profile

Houston Methodist (HM) is one of the nation’s leading health systems and academic medical centers.  HM consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the heart of the Texas Medical Center, and seven community hospitals throughout the greater Houston metropolitan area.  HM also includes an academic institute, a comprehensive residency program, a global business division, numerous physician practices and several free-standing emergency rooms and outpatient facilities.  Overall, HM employs over 25,000 employees.   Houston Methodist is supported by a wide variety of business functions that operate at the system level to help enable clinical departments to provide the best patient care and service in a spiritual environment.

 

In 2019 Houston Methodist and its physicians treat more than 6,333 international patients from more than 76 countries. Houston Methodist Global Health Care Services’ consulting and education divisions also provide advisory services and training and development to health care organizations around the world.

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Equal Employment Opportunity

Houston Methodist is an Equal Opportunity Employer.

Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law. VEVRAA Federal Contractor – priority referral Protected Veterans requested. Application FAQs

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