Compliance Data Analyst

Clinical Practice Association Billing Quality Assurance is seeking a Compliance Data Analyst who will support internal department reporting needs in managing compliance risks. Facilitates the generation of risk-based data mining within Epic and other audit software applications, under the general direction of the Senior Director, Compliance & Training. Analyzes, interprets and summarizes professional fee billing data and trends. Determines areas of risk, stays abreast of all federal and state regulatory requirements in order to assist in risk mitigation, and ascertain impact of noncompliance for the organization. Is responsible for generating reports and data used as part of auditing and monitoring efforts under the professional fee billing Compliance Program.

Specific Duties & Responsibilities:

Analyzes, interprets, summarizes and distributes routine reports in accordance with billing compliance processes. Analyzes reports to determine areas of improvement in need of further investigation; assist in determining appropriate plan of action and works with appropriate stakeholders to rectify any billing problems impacting compliance. Responsible for generating data mining reports from Epic and other audit software applications for the Compliance Auditors and management team as necessary. Assists compliance team members and management in developing, enhancing, and maintaining standard processes, reports, and reference data to support accurate, consistent, efficient, and quality service to both internal and external customers. Consults with Compliance Director(s) and Professional Billing Services personnel when relevant issues of federal and state health care billing law and regulations are discovered to create overpayments. Keeps abreast of ICD-10, CPT-4, and HCPCS coding changes, compliance issues and regulations and provides communication and updates regarding changes in regulations, policies or procedures pertaining to the Compliance Program. Use system applications to help with identifying areas of risk for Johns Hopkins Medicine (JHM) Assures quality and validates required data. Works closely with Professional Billing Services (PBS) EPIC business analysts when areas of risk are identified. Participates in risk assessment process, including areas of focus designated by the Medicare Administrative Contractors (MACs), Recovery Audit Contractors (RACs), OIG, ZPIC and other regulatory agencies. Support routine and special compliance projects. Perform other compliance related activities as necessary.

Scope of Responsibility

• Works within the formal and informal goals, standards, policies, and procedures of Johns Hopkins Medicine, the Office of Johns Hopkins Physicians, the Clinical Practice Association, and the Johns Hopkins Health System.
• Is sensitive to the relationship of both people and functions within the department, the Clinical Practice Association and JHHS Corporate Compliance Office.

Decision Making

• On a regular and continual basis, exercises administrative judgment and assumes responsibility for decisions, consequences, and results having an impact on people, costs, and/or equality of service within the functional area.
• Routinely handles confidential patient information and sensitive financial information.

Authority

• Identifies and implements routine process and operational improvements of department reporting capabilities independently, conferring with the Senior Director when there is a major change to workflow or processes.

Communications

• Exchanges non-routine information using tact and persuasion as appropriate requiring good oral and written communication skills.

This description is a general statement of required major duties and responsibilities performed on a regular and continuous basis. It does not exclude other duties as assigned.

Minimum Qualifications (Mandatory):

• Bachelors in Business, Health Admin, Project Management, or other related field.
• Masters preferred, and may substitute for some experience.
• Minimum of five (5) years of related experience required. Additional experience may substitute for some education.*

* JHU Equivalency Formula: 30 undergraduate degree credits (semester hours) or 18 graduate degree credits may substitute for one year of experience.  Additional related experience may substitute for the required education on the same basis. For jobs where equivalency is permitted, up to two years of non-related college course work may be applied towards the total minimum education/experience required for the respective job.

** Applicants who do not meet the posted requirements but are completing their final academic semester/quarter will be considered eligible for employment and may be asked to provide additional information confirming their academic completion date.

Certifications:

• None required upon hire.
• A minimum of one coding certification preferred.
• Certification in healthcare compliance also preferred.

Special Knowledge, Skills & Abilities:

• Must be highly motivated, productive, results-oriented, credible, professional, articulate, creative problem solver, flexible, and able to work collaboratively with a wide range of professional colleagues.
• Requires strong communication, problem-solving, analytical and organizational skills in order to assess information and issues and provide recommendations based on data analysis or operational performance.
• Must handle confidential and sensitive information in a discreet and professional manner. Must demonstrate sound and prudent judgement and the highest degree of integrity in all business matters.
• Proficient in Microsoft office applications including Excel and Word, Outlook, and internet usage. Advanced level of proficiency and knowledge of Microsoft Excel, Pivot tables.
• Must be flexible to adjust to the development and refinement of new processes and procedures.
• Strong background in regulatory rules and guidelines and risk-based trends in healthcare.

Physical Requirements:

• Sitting in a normal seated position for extended periods of time.
• Reaching by extending hand(s) or arm(s) in any direction.
• Finger dexterity required to manipulate objects with fingers rather than with whole hand(s) or arm(s), e.g., use of keyboard.
• Communication skills, using the spoken word.
• Ability to see within normal parameters, ability to hear within normal range and ability to move about.

Classified Title: Practice Management Analyst
Working Title: Compliance Data Analyst
Role/Level/Range: ATP/04/PE
Starting Salary Range: $69,830 - $95,960 annually (commensurate with experience)
Employee group: Full Time
Schedule: M-W 8:30-5
Exempt Status: Exempt
Location: School of Medicine Campus
Department name: SOM Admin CPA Billing Quality Assurance
Personnel area: School of Medicine

The successful candidate(s) for this position will be subject to a pre-employment background check.

If you are interested in applying for employment with The Johns Hopkins University and require special assistance or accommodation during any part of the pre-employment process, please contact the Talent Acquisition Office at jhurecruitment@jhu.edu. For TTY users, call via Maryland Relay or dial 711.

Johns Hopkins has mandated COVID-19 and influenza vaccines, as applicable. Exceptions to the COVID and flu vaccine requirements may be provided to individuals for religious beliefs or medical reasons. Requests for an exception must be submitted to the JHU vaccination registry. For additional information, applicants for SOM positions should visit https://www.hopkinsmedicine.org/coronavirus/covid-19-vaccine/ and all other JHU applicants should visit https://covidinfo.jhu.edu/health-safety/covid-vaccination-information/.

The following additional provisions may apply, depending on campus. Your recruiter will advise accordingly.

The pre-employment physical for positions in clinical areas, laboratories, working with research subjects, or involving community contact requires documentation of immune status against Rubella (German measles), Rubeola (Measles), Mumps, Varicella (chickenpox), Hepatitis B and documentation of having received the Tdap (Tetanus, diphtheria, pertussis) vaccination. This may include documentation of having two (2) MMR vaccines; two (2) Varicella vaccines; or antibody status to these diseases from laboratory testing. Blood tests for immunities to these diseases are ordinarily included in the pre-employment physical exam except for those employees who provide results of blood tests or immunization documentation from their own health care providers. Any vaccinations required for these diseases will be given at no cost in our Occupational Health office.

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