***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.

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 Model

• Delivers personalized service using HM Service Standards

• Provides 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 job

• Displays cultural humility, diversity, equity and inclusion principles

• Actively supports the organization's vision, fulfills the mission and abides by the I CARE values

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 requirements

• Remains 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.

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 setting

• Demonstrated application of government billing and collections

• Government billing and collections experience in a hospital setting

• Epic experience in HB preferred

LICENSES AND CERTIFICATIONS - REQUIRED

• N/A

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 evaluations

• Sufficient 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 security

• Ability 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 principles

• Ability to analyze and solve problems

• Ability to work independently and interdependently

• Appreciation of cultural diversity and sensitivity towards target populations

• Strong interpersonal skills and demonstrated ability to work with multidisciplinary groups and teams

• Knowledge of CMS payment methodology and billing compliance

• Knowledge of regulatory requirements as they relate to billing and collections in a hospital setting

• Knowledge of process improvement tools and techniques

• Knowledge of MS Office Suite

• Knowledge of process/performance improvement principles, a plus

• Knowledge of Lean and Six Sigma tools and methodology, preferred

• Proven time management skills and ability to meet deadlines

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

• Uniform No
• Scrubs No
• Business professional Yes
• Other (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 Yes
• May require travel outside Houston Metropolitan area No

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.