Senior Billing Compliance Analyst

Accountabilities:

• • Lead and manage complex hospital and professional billing compliance audits, reviews, investigations, and special projects, ensuring findings are accurate, well-supported, and aligned with applicable regulations.
  • Analyze billing, coding, charging, and operational data to identify compliance risks, systemic issues, trends, and root causes, using audit results and investigations to develop actionable recommendations.
  • Evaluate compliance with federal and state regulations, CMS billing requirements, OIG focus areas, payer-specific policies, and applicable coding guidelines.
  • Serve as a billing compliance subject matter expert, advising operational leaders, compliance teams, coding departments, revenue cycle stakeholders, and clinical functions on appropriate billing and charging practices.
  • Develop and maintain billing compliance training, awareness initiatives, policies, procedures, and implementation guidance based on emerging regulatory requirements and identified risks.
  • Monitor regulatory developments, healthcare industry publications, government resources, and other authoritative sources to assess their potential impact on billing operations.
  • Manage the billing compliance policy and procedure lifecycle, incorporating stakeholder feedback and recommending updates, best practices, and process improvements.
  • Prepare clear, professional audit reports, correspondence, executive-level summaries, and other compliance documentation that effectively communicate complex findings and recommendations.
  • Present audit conclusions, risk assessments, and recommendations to leadership and collaborate with stakeholders to support remediation and sustainable compliance improvements.
  • Exercise independent judgment when addressing non-routine compliance issues while coordinating the work of colleagues and cross-functional partners without direct supervisory responsibility.

  Requirements:

  • Minimum of 5 years of experience in healthcare billing, coding, or compliance, with recent 3–5 years of Epic HB or PB Billing Compliance experience required.
  • High school diploma or GED required; a bachelor’s degree in Business, Healthcare Administration, Health Information Management, or a related field is preferred.
  • Certified Healthcare Compliance (CHC) certification is preferred but not required.
  • Advanced knowledge of ICD-10-CM, CPT, and HCPCS coding systems, coding guidelines, and federal and state healthcare billing regulations.
  • Strong understanding of CMS billing guidelines, OIG Work Plan focus areas, payer-specific requirements, and healthcare regulatory environments.
  • Advanced knowledge of Epic, including charge router logic, clinical workflows, charging methodologies, and billing processes.
  • Demonstrated experience conducting compliance audits, investigations, data analysis, and risk assessments, preferably involving large and complex datasets.
  • Strong analytical capabilities, including financial analysis, root-cause analysis, audit test work, and the ability to translate data into meaningful compliance conclusions.
  • Excellent written and verbal communication skills, with the ability to explain complex regulatory and analytical information clearly to executives, directors, and other stakeholders.
  • Strong presentation, organization, project management, and stakeholder collaboration skills, with the ability to manage multiple priorities independently.
  • Proficiency with Microsoft 365 and other relevant business and analytical software.
  • Ability to work effectively with healthcare professionals, operational teams, internal customers, and senior leadership in a collaborative environment.

  Benefits:

  • Remote work opportunity based in Oklahoma, United States.
  • Competitive compensation aligned with experience, qualifications, and job-related factors.
  • Opportunity to work in a senior, highly visible billing compliance role with frequent interaction with Director-level and above stakeholders.
  • Meaningful opportunity to influence healthcare billing compliance, risk management, training, and process improvement.
  • Collaborative environment involving compliance, revenue cycle, coding, clinical, and operational teams.
  • Opportunity to apply advanced analytics and healthcare compliance expertise to complex organizational challenges.
  • Equal opportunity workplace with reasonable accommodations available for qualified individuals with disabilities.
  • Benefits and other employment offerings may apply based on eligibility and organizational policies.