A senior level Compliance Examiner and Analyst who works with the Compliance Officers to examine and analyze fraud, waste and abuse, compliance, and privacy related activities.
Responsibilities
Examine and analyze fraud, waste and abuse, compliance, and privacy related activities
Assess compliance with CPT, ICD-9/10, HCPCS, Payor guidelines, CMS guidelines, state and federal guidelines, cash controls, and TGC policies
Analyze internal and external risks and develop a Work Plan to detect, audit, analyze and report findings to Compliance officers and leadership partners
Develop and provide guidance to improvement teams related to improving conditions that may have caused errors
Conduct concurrent, prospective, and retrospective audits of medical record documentation, billing activity, provider activity, service lines, department processes, financials, contracts, assets, licensure/certification, etc.
Requirements
CPC (Certified Professional coder) required
LPN or CPMA preferred
Certifications from AHIMA (RHIA, RHIT, or CCS) or AAPC considered
Provides patient-centered access to services at St. Peter’s Health Medical Group clinics and Regional Medical Center, managing registration, scheduling, insurance verification, referrals, authorizations, and payments.
Responsibilities
Delivers excellent customer service while managing patient registration
Schedules appointments
Verifies insurance
Handles referrals and authorizations
Processes applicable payments
Requirements
High School Diploma
GED
HiSET GED
Nice to have: 1-2 years of hospital admissions or provider office experience
Nice to have: customer service or scheduling experience in a healthcare setting
The Patient Access Representative is responsible for greeting patients, verifying insurance information, registering patients for services, collecting payments, scheduling appointments, and maintaining accurate patient records, all while ensuring the integrity of the Master Patient Index.
Responsibilities
Greet and assist patients, families, and visitors with professionalism, empathy, and a sense of urgency.
Complete timely and accurate patient registration, including collection and verification of demographic, insurance, and financial information.
Obtain necessary patient signatures on consent forms, privacy notices, and financial documents, ensuring compliance with hospital and legal requirements.
Verify insurance eligibility and benefits using electronic tools or direct contact with payers, and update records accordingly.
Determine and collect patient co-pays, deductibles, or deposits as appropriate; provide information about financial assistance programs when needed.
Lead the Accounts Receivable team within the Hospital District’s Patient Financial Services, overseeing payment processing, reconciliation, and compliance.
Responsibilities
Process daily patient payments and bank lockbox reconciliations
Maintain accurate posting to General Ledger
Ensure compliance with HIPAA and HMHD standards
Utilize contract management software to review and correct payment variances
Collaborate with collectors and managers to resolve posting errors
Responsible for ensuring accuracy, compliance, and optimization of charge capture, coding, billing, and reimbursement processes across the organization.
Responsibilities
Conduct routine charge reconciliation and charge capture audits
Investigate and resolve charge exceptions and revenue leakage opportunities
Analyze billing edits, claim denials, and reimbursement variances
Review charge master and fee schedule accuracy
Monitor service line charging practices
Requirements
Associate's degree required
Bachelor's degree in Healthcare Administration, Business Administration, Finance, or related field preferred
The Quality Assurance (QA) Auditor evaluates the accuracy, completeness, and compliance of Patient Access workflows to support high‑quality registration practices and reduce preventable technical denials across Baptist Health.
Responsibilities
Evaluate accuracy, completeness, and compliance of Patient Access workflows
Conduct comprehensive audits including random reviews, targeted audits based on denial trends, and ongoing monitoring following training interventions
Partner with Patient Access leadership, Denials Specialists, and the Training and Education team to identify performance gaps
Validate staff competency and provide actionable feedback that drives continuous improvement
Requirements
Bachelor’s degree in Business Administration, Healthcare Administration, Health Information Management, or related field
Review, process, and audit chemotherapy regimens for medical necessity and obtain pre-certifications to ensure timely reimbursement.
Responsibilities
Reviews, processes and audits the medical necessity for each patient chemotherapy treatment and documentation of regimen relative to pathway adherence.
Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans.
Provides prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered chemotherapy drugs.
Updates coding/payer guidelines for clinical staff.
Tracks pathways and performs various other business office functions on an as needed basis.
Requirements
High school degree or equivalent
Associate degree in Healthcare, LPN state license and registration preferred
Responsible for abstracting and validating CPT, ICD-10 and HCPCS codes for inpatient, outpatient and physician's office/clinic settings, maintaining coding compliance and serving as a subject matter expert for assigned specialty.
Responsibilities
Abstracts/codes for assigned provider(s)/division(s) based on medical record documentation
Utilizes appropriate coding software and resources to determine correct codes
Communicates billing related issues to assigned supervisor/manager and participates in meetings to improve overall billing
Follows departmental policies for charge corrections
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