As a UW employee, you have a unique opportunity to change lives on our campuses, in our state and around the world. UW employees offer their boundless energy, creative problem-solving skills and dedication to build stronger minds and a healthier world.

UW faculty and staff also enjoy outstanding benefits, professional growth opportunities and unique resources in an environment noted for diversity, intellectual excitement, artistic pursuits and natural beauty.

The School of Medicine has an outstanding opportunity for a Hospital Billing Compliance Manager to join their team.

Hospital Billing Compliance Manager (payroll title: Compliance Analyst Manager) reports directly to the Director and is responsible for overseeing and coordinating systems and initiatives required to establish an effective hospital billing compliance program for UW Medicine.

At the direction of the Director, the Hospital Billing Compliance Manager develops and implements UWM compliance program strategic goals, oversees applicable elements of an effective compliance program as outlined by the Federal Sentencing Guidelines, directs resources to accomplish the goals and mission of the unit, and ensures efficient and effective operations.

The Hospital Billing Compliance Manager also works cooperatively with other UWM compliance leaders, the CCO/AVPMA, UW Health Sciences risk managers, and entity leaders to identify and resolve shared issues and concerns.

Internally, the Hospital Billing Compliance Manager works closely with the Director to develop unit-wide expectations for employees, maintain and monitor staffing levels, identify, and document critical knowledge-skills-attributes for employees, and establish strategic plans for recruiting and retaining quality staff. The Hospital Billing Compliance Manager ensures that the performance evaluation and reward system achieve unit goals for excellence and employee motivation.

This position supervises hospital billing compliance staff by setting clear standards of service and high-quality performance, regularly monitoring performance against established standards, providing ongoing feedback to team members and offers appropriate guidance. The Individual in this position holds employees accountable for achieving performance standards and rewards and recognizes exemplary performance while appropriately addressing poor performance.

The Hospital Billing Compliance Manager is a full partner with the Director in developing the short-term and long-range strategic goals for both unit-based and system-wide compliance operations, initiatives, and projects, and serves as project director for major initiatives.

As a confidential assistant to the AVPMA/CCO and Director, the Hospital Billing Compliance Manager uses discretion to advance issues on behalf of the AVPMA/CCO and Director and operates independently using judgment and discretion to handle sensitive operational, implementation, and organizational concerns.

DUTIES AND RESPONSIBILITIES

Oversee daily activities associated with the risk areas and program functions under the auspices of the Director, advise the Director about program operations and risk assessment/mitigation strategies, monitor regulatory developments, and recommend program modifications.

Effectively supervise and allocate resources and talent to meet program objective(s).

Manage the development and implementation of policies and procedures for UWM Compliance, working closely with the Director, enterprise-wide content experts, legal counsel(s), and administrative staff.

Demonstrate team leadership by effectively managing, both directly and through influence, and guiding teams and group efforts; provide an appropriate level of feedback concerning progress to execute unit goals.

Develop proactive and reactive education and training content sufficient to address and mitigate organizational compliance-related risk.

Ensure effective monitoring, auditing, and risk assessment activities; conduct risk audits.

Participate and or lead enterprise-wide risk analysis as needed and report findings as well as mitigation plans to the Director.

Effectively engage in the development and implementation of the annual Compliance work plan, coordinating with the Director, AVPMA/ CCO, other directors and enterprise-wide compliance officials and content experts.

Serve as a resource for current documentation, coding, billing, and related regulatory guidelines.

Maintain and report regularly on program activities, work plans, project plans, and investigatory mitigation plans.

Participate in or convene institutional committees and/or workgroups as assigned by the Director.

Serve as in-house expert on matters of regulatory compliance and maintain awareness of laws, regulations, and status of current enforcement initiatives.

In conjunction with the AVPMA/CO, unit directors, managers, and other staff, develop and implement effective policies and procedures that address regulatory requirements, including hotline, triage/case management, investigations and resolutions, inquiries, complaints, and consultation requests.

Oversee creation and maintenance of written documentation for the Compliance Program (e.g., committee minutes, charters, process improvement projects, corrective action plans) as required by applicable regulations; retain records in accordance with the UW Records Retention Schedule.

Performs compliance investigations or evaluations of compliance issues, inquiries, or concerns; reviews relevant information, including but not limited to: patient records, billing records, records related to hospital marketing efforts, arrangements with other parties, including employees, professionals on staff, independent contractors, suppliers, agents, and hospital-based physicians. Performing in depth research on the topic, analyzing data and findings, preparing draft reports, participates in follow-up education, outreach, and/or other recommended corrective actions or improvements. Monitor and validate implementation of corrective actions. Communicate findings, corrective actions, and monitoring implementation of corrective action with all levels of leadership.

Review external government audits for opportunities to appeal denials as supported by clinical documentation, coding and billing guidelines, federal and state policies, and other relevant regulatory and industry criteria.

Analyze audit data and prepare reports for tracking and trending of external government payer audit activities.

Provide feedback and education on the results of audits and collaboratively establish corrective action plans.

Work closely with other university officials when there are mutual concerns, system-wide policy needs, and urgent or emergent issues.

The position operates independently using judgment and discretion to handle sensitive compliance program and political issues.

MINIMUM QUALIFICATIONS

Bachelor's degree in a Health Sciences discipline, Business Administration, or related field.

Seven or more years of healthcare administration, management, or compliance leadership experience in a complex organization and three or more years’ experience managing staff.

Additional Requirements:

Current coding certification: CIC, COC, CCS, CCS-P, RHIT, RHIA or CDIP.

Ability to lead, inspire and develop a team of high performing individuals.

Extensive knowledge of ICD-10-PCS, ICD-10-CM, CPT, Clinical Documentation Improvement, and HCPCS coding principles and guidelines.

Comprehensive knowledge of federal and state regulations related to documentation, coding, and billing.

Strong financial management, strategic planning, project management, business, and operations management experience.

Excellent cross-group collaboration skills demonstrated executive maturity and ability to impact and influence people at all levels in the organization.

Must demonstrate strategic thinking, business insight and creativity in resolving problems.

Coding, documentation, and reimbursement content area expertise in one or more of the

following: utilization management, medical necessity, clinical documentation improvement, inpatient coding, or outpatient coding.

Proficiency with MS Word and Excel.

Excellent oral and written communication skills.

Self-motivated, detail-oriented, and highly organized skill set.

Equivalent education and/or experience may substitute for minimum requirements.

DESIRED QUALIFICATIONS

Experience in an academic medical center.

Certified in Healthcare Compliance (e.g., HCCA/HCCB CHC certificate).

Proficiency with electronic medical records systems, databases, and related automated systems.

Working knowledge of university financial and human resources-based operating systems.

Statistical analysis and data benchmarking proficiency.

Experience with auditing processes.

The application process for UW positions may include completion of a variety of online assessments to obtain additional information that will be used in the evaluation process. These assessments may include Work Authorization, Cover Letter and/or others. Any assessments that you need to complete will appear on your screen as soon as you select “Apply to this position”. Once you begin an assessment, it must be completed at that time; if you do not complete the assessment, you will be prompted to do so the next time you access your “My Jobs” page. If you select to take it later, it will appear on your "My Jobs" page to take when you are ready. Please note that your application will not be reviewed, and you will not be considered for this position until all required assessments have been completed.