Senior Compliance Associate - Hospital Billing

The Senior Compliance Associate - Hospital Billing reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards. The Senior Compliance Associate assists the department managers and directors in the implementation of all aspects of the NMHC Corporate Compliance Program, including leading key initiatives as may be required. Responsibilities:Respond to hospital billing compliance inquiries and concerns received through multiple reporting mechanisms, including the Compliance Hotline, by assessing issues, providing guidance, triaging matters to appropriate stakeholders, and maintaining accurate documentation of reports and resolutions.Conduct and support compliance investigations, as they relate to hospital billing, by gathering and analyzing relevant information, interviewing stakeholders as appropriate, identifying root causes, documenting findings, and developing recommendations for corrective action and process improvement. Lead compliance reviews and associated follow ups related to hospital billing and inpatient services, which may include, assessing billing accuracy, coding compliance, documentation sufficiency, medical necessity, and adherence to state and federal requirements. Serve as a coordinator for regulatory inquiries, audits, and investigations, including matters involving CMS, OIG, and other federal and state agencies; assist with medical record review, claim review, quality assurance of clinical documentation and response preparationIdentify, assess, and monitor healthcare compliance risks across the health system; proactively recognize emerging issues, recommend mitigation strategies, and elevate concerns to leadership for timely resolutionMaintain a current understanding of regulatory trends and changes in compliance and regulatory guidelines that affect the health system and its subsidiaries by monitoring various resources to assess regulatory changes and determine organizational impactAssist with the development and implementation of the department’s annual Compliance Work PlanHelp develop and maintain compliance-related policies and procedures to ensure they are current and relevant. Assist with providing policy-related guidance to individuals and departmentsCoordinate and facilitate agendas and materials for compliance-related committeesHelp develop department and organizational metrics to clearly and efficiently monitor the organization’s compliance with various rules and regulations, policies and procedures, etc.Perform other duties assigned by the department Manager, Director, or VP, Integrity