Research Billing Compliance Analyst II

Orlando, Florida, Description All the benefits and perks you need for you and your family: · Benefits from Day One · Sign-on Bonus* · Paid Days Off from Day One · Debt-free Education* (Certifications and Degrees without out-of-pocket tuition expense) Our promise to you: Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that  together  we are even better. Schedule:  Full Time, Days Shift :    Monday – Friday The community you’ll be caring for: ·        Located on a lush tropical campus, our flagship hospital, 1,368-bed AdventHealth Orlando ·        We offer great benefits with immediate Health Insurance coverage ·        Career growth and advancement potential ·        Serves as the major tertiary facility for much of the Southeast, the Caribbean and South America ·        AdventHealth Orlando houses one of the largest Emergency Departments and largest cardiac catheterization labs in the country ·        We are already one of the busiest hospitals in the nation, providing service excellence to more than 32,000 inpatients and 125,000 outpatients each year The role you’ll contribute:  AdventHealth Research Institute (AHRI) provides corporate level research oversight across all markets to ensure that research is performed in a consistent manner that is in full alignment with all applicable federal, state and local rules and regulations. The Research Billing Compliance Analyst II (RBCA II) is integral to the effectiveness and success of the Research Compliance Program of the AHRI through responding to research compliance related inquiries, conducting research billing compliance reviews and monitoring of research billing processes at the corporate level for research participants for hospital and professional billing system wide. Primary efforts and responsibilities are centered on the prevention, detection and reporting of Medicare Fraud and Abuse. The RCBA II operates independently conducting internal compliance reviews and quality assurance/quality improvement monitoring to assess compliance with federal and state laws, regulations, guidance, and standards, as well as AHRI Policies & Procedures (P&Ps) related to research billing integrity and compliance. The RBCA II records and submits a report of findings, assists in Corrective and Preventative Action Plan (CAPA) development, and follow-up to ensure the study team resolves all findings and completes the CAPA adequately.

The RBCA II will prepare and provide any requested and/or required reporting to the AdventHealth Research Council (ARC), Research Oversight Committee (ROC), Corporate Responsibility, and AHRI senior leadership and work collaboratively with Corporate Responsibility to ensure research billing compliance and integrity. The value you’ll bring to the team: Working knowledge of federal regulations and standards related to clinical research billing, and grants. These may include, but are not limited to, the following:   Department of Health and Human Services, Office of Human Research Protections, Office of Research Integrity, Food & Drug Administration, Office of the Inspector General, Office of Civil Rights, Centers for Medicare and Medicaid. Ability to recognize noncompliance with federal regulations and consult with Director for clarification and assistance in the interpretation of regulations when appropriate, escalating research billing integrity issues when suspected to be systemic in nature or as directed. Ability to locate appropriate sources of research-related federal regulations and guidance documents for independent research and review. Expertise in the concepts of routine costs versus research-related costs, research budget build, Medicare coverage analysis (MCA), Medicare Fraud and Abuse laws, Stark law, Anti-Kickback statute, cost sharing, time and effort, indirect costs or overhead, and fair market value (FMV) as related to clinical research. Ability to develop and implement compliance monitoring steps and project plans and implement them. Ability to independently conduct detailed and thorough analysis and compliance reviews of research billing practices and processes. Ability to identify process improvement opportunities and provide recommendations and/or implement new processes. Excellent verbal and written communication skills, including proficient writing skills as demonstrated by writing thorough and concise reports of completed compliance reviews and monitoring reports.

Analytical and critical-thinking skills are necessary to anticipate and identify potential problems and for problem solving. Ability to work well independently, attention to detail, organized, self-starter. Good time management and organizational skills. Ability to effectively communicate and collaborate with a variety of professionals and other departments including operations, clinical, financial, and administrative. Proficient in Microsoft Office Suite, particularly Outlook, Word, and Excel. Ability to maintain strict confidentiality of employees, other research team members, patients, research subjects and institution information. Ability to recognize a high standard of ethics in research operations. Qualifications The expertise and experiences you’ll need to succeed: EDUCATION AND EXPERIENCE REQUIRED: Bachelor’s degree in healthcare (healthcare finance, medical coding, administration or research-related field); AND Five years of work experience in healthcare billing, research billing, medical coding or revenue cycle.   EDUCATION AND EXPERIENCE PREFERRED: ·        Master’s degree in healthcare, administration, or research related field. ·        Five years or more of experience in research (clinical trials) or grants (pre-award or post-award) ·        Experience in area of research billing compliance, medical coding or revenue cycle management in a medical practice or hospital setting.

·        Auditing/monitoring of billing practices in a healthcare system. ·        Experience working with outside counsel, and external auditors.   LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED: ·        Certification in Healthcare Research Compliance (CHRC) through the Compliance Certification Board (CCB) ·        Certification through any professional research organization such as The Society of Clinical Research Associates (SOCRA), Association of Clinical Research Professionals (ACRP), or Society of Research Administrators International (SRA); OR Certified Professional Coder (CPC) through a healthcare professional organization such as American Academy of Professional Coders (AAPC) or National Health career Association (NHA).   This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

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