Lead, Healthcare Compliance

Title: Lead, Healthcare Compliance

Location: Houston, TX, US

Workplace: Remote within Houston, TX

Department: Business Operations

Job Description:

Leads and conducts activities related to the development, communication, oversight, and monitoring of healthcare compliance programs within the College. The ideal candidate will have direct healthcare compliance experience gained in a healthcare or educational institution, including experience with clinical processes, revenue cycle, research, grants and contracts, and education processes.

Job Duties

• Leads and conducts activities related to the development, communication, oversight, and monitoring of healthcare compliance programs within the College.
• Communicates with contacts both within and outside of function on matters that require explanation, interpretation, and/or advising. May require communication with senior leadership. 
• Influences parties within the department regarding concepts, practices and approaches. 
• Coaches, reviews and delegates work to lower-level professionals.
• Manages moderately complex projects or processes. May manage large projects or processes that span outside of the department. 
• Works to achieve operational, functional, and/or business targets with significant impact on departmental results.
• Recognized subject matter expert; helps develop new and improved products, processes and systems within the department.
• Contributes to the development of goals and planning efforts for the department. 
• Identifies billing and coding inconsistencies and coordinates with professional team to communicate the findings and provide the most current guidelines.
• Understands, interprets and applies coding guidelines for coding audits.
• Audits inpatient and outpatient encounters code assignments; generates and distributes reports of clear and accurate audit findings at both practice and provider level; outlines findings and recommendations for improvement of documentation. 
• Researches and evaluates coding, documentation practices, and processes, and identify billing policy and coding trends through data analysis or chart review.
• Reviews medical records to determine coding accuracy of all documented diagnoses and procedures. 
• Reviews claims to validate submitted codes and abstracted data, and discharge disposition which all impact facility reimbursement. 
• Provides individual and group education/presentations to coding staff, physicians, and others throughout the organization that require coding knowledge; monitors and reports progress to ensure compliance with coding standards and expectations.
• Monitors work quality and team productivity to ensure adherence to department standards. 
• Develops and trains other team members.
• Performs other job-related duties as assigned.

Minimum Qualifications

• Bachelor's degree.
• Six years of relevant experience.

Preferred Qualifications and Skills

• In-depth knowledge of federal and state healthcare regulations (e.g., HIPAA, HITECH, ACA) and relevant standards (e.g., CMS).
• Proficiency in data analysis and relevant compliance management software.
• Strong analytical, critical thinking, and problem-solving skills. 
• Excellent written and verbal communication, negotiation, and interpersonal skills. 
• Requires mastery of specialty area and working knowledge of industry practices/other areas, typically obtained through advanced education and strong experience.

Baylor College of Medicine is an Equal Opportunity/Affirmative Action/Equal Access Employer.