JOB DESCRIPTION FOR JOB TITLE:



|Compliance Program Manager – Research Billing |

|Job Code: 443000 |FLSA Status: Exempt |Mgt. Approval: T. Lepien |Date: Feb 2021 |

|Department: Business Integrity-Compliance Hospital |HR Approval: J. Middleton |Date: Feb 2021 |

|JOB SUMMARY |

|The UW Health Business Integrity Department has separate Divisions based on regulatory need. There are Divisions for Professional Service Compliance, Hospital |

|Compliance, Privacy, Internal Audit, Pharmacy Compliance and Research Billing Compliance. These Divisions are cooperative endeavors between UWHC, UWMF, and UWSMPH that|

|ensures activities are compliant with relevant laws, regulations, best practices, and internal policies. These Divisions also ensures workflows are performed |

|transparently, effectively, and efficiently and are managed to best support and advance UW Health’s mission. |

|Under the direct supervision of the UW Health VP Business Integrity, the incumbents will oversee the day to day operations for the Research Billing Compliance Divisions|

|(Divisions). This includes the oversight and management of staff. In addition, it is the expectation that these individuals are responsible for the coordination with |

|representatives from all levels of management and departments within UW Health and SMPH. These individuals will chair and staff oversight committees for these programs |

|that will assist in the advancement of the Division’s missions. |

|This position requires a working knowledge of/ability or regulatory to learn applicable policies and procedures of various UW entities as well as applicable state and |

|federal regulations and guidelines. |

|MAJOR RESPONSIBILITIES |

| |

|Use independent judgement and apply a comprehensive understanding of regulations and policies in administering processes to ensure: |

|Are structured as to comply with CMS, FDA, HRSA, and other governmental regulatory requirements related to research billing compliance |

|Operational departments have developed appropriate workflows to comply with the appropriate regulations |

|Establish and oversee the day to day operations of the Research Billing Compliance Division. In collaboration with the VP Business Integrity establish and execute the |

|Division’s quality, efficiency, and effectiveness metrics and periodically assess workload volume, capacity, and turnaround statistics to determine appropriate staffing|

|levels and skill sets. This would include oversight of staff and direct reports |

|Facilitate budget preparations by assisting with Division cost projections and determinations |

|Providing regular reports to the UW Health Compliance Committee, a subcommittee of the Board of Directors |

|Co-Chairing Workgroups/Taskforces (i.e. Research Billing Compliance Committee) multifunctional teams that include representatives from UW Health, SMPH, Affiliates and |

|Joint Ventures. Including the development of agendas, meeting materials, minutes, and action items. |

|Oversee the Research Billing Compliance Division’s training efforts, spanning all educational formats (e.g., computer based training, classroom, 1:1, written |

|materials, website) and across a diverse audience base (e.g., new employees, new leaders, Revenue Cycle, ), to ensure a workforce that is knowledgeable about and |

|compliant with applicable regulations and policies. |

|Oversee and complete routine surveillance audits (e.g. . Medicare Coverage Analysis, Research Billing Analysis, Clinical Trial Reviews, UW Research and Sponsored |

|Programs contracts, informed consent documents, etc.) |

|Complete analysis of data looking for irregularities and outliers signaling the need for audit or investigation. |

|Oversee and complete Investigations of potential billing irregularities and program adherence. |

|In collaboration with VP of Business Integrity and Office of Corporate Counsel respond to external regulatory agencies |

|Provide consulting services for new subject matter initiatives (e.g. research billing modules, etc.) |

|Serve as the Program’s primary liaison to management and governance for issues related to the Research Billing Compliance Division |

| |

|ALL DUTIES AND REQUIREMENTS MUST BE PERFORMED CONSISTENT WITH THE UW HEALTH PERFORMANCE STANDARDS. |

|JOB REQUIREMENTS |

|Education |Minimum |Graduate of a Medical Coding Program or Associates degree in healthcare related field. Two (2) years |

| | |experience will be considered in lieu of education. |

| |Preferred |Bachelor’s degree in healthcare related field. |

|Work Experience |Minimum |Seven (7) years of research billing related compliance experience |

| |Preferred |Ten (10) years of research billing related compliance experience |

|Licenses & Certifications |Minimum | |

| |Preferred |Certified Research Coordinator (CRC), Certified Professional Coder (CPC), and Certified in Healthcare Research|

| | |Compliance (CHRC) |

|Required Skills, Knowledge, and Abilities |CMS, FDA, DEA, OPA, HRSA, and other governmental regulatory requirements Working knowledge of medical |

| |terminology, medical billing, and billing compliance |

| |Ability to work collaboratively with others |

| |Strong analytical, communication (written and oral) and complex problem-solving skills |

| |Proficient with Excel and Word |

| |Ability to communicate effectively with Governance, management, investigators, and staff |

| |Demonstrate attention to detail and the ability to identify outliers and issues with workflow creating risk |

| |Effective leadership skills, ability to create a positive, trusting, respectful, and supportive work |

| |environment |

| |

|PHYSICAL REQUIREMENTS |

|Indicate the appropriate physical requirements of this job in the course of a shift. Note: reasonable accommodations may be made available for individuals with |

|disabilities to perform the essential functions of this position. |

|Physical Demand Level |Occasional |Frequent |Constant |

| |Up to 33% of the time |34%-66% of the time |67%-100% of the time |

|x |Sedentary: Ability to lift up to 10 pounds maximum and occasionally |Up to 10# |Negligible |Negligible |

| |lifting and/or carrying such articles as dockets, ledgers and small | | | |

| |tools. Although a sedentary job is defined as one, which involves | | | |

| |sitting, a certain amount of walking and standing is often necessary | | | |

| |in carrying out job duties. Jobs are sedentary if walking and | | | |

| |standing are required only occasionally and other sedentary criteria | | | |

| |are met. | | | |

| |Light: Ability to lift up to 20 pounds maximum with frequent lifting |Up to 20# |Up to 10# or requires |Negligible or constant |

| |and/or carrying of objects weighing up to 10 pounds. Even though the | |significant walking or |push/pull of items of |

| |weight lifted may only be a negligible amount, a job is in this | |standing, or requires |negligible weight |

| |category when it requires walking or standing to a significant degree.| |pushing/pulling of arm/leg | |

| | | |controls | |

| |Medium: Ability to lift up to 50 pounds maximum with frequent |20-50# |10-25# |Negligible-10# |

| |lifting/and or carrying objects weighing up to 25 pounds. | | | |

| |Heavy: Ability to lift up to 100 pounds maximum with frequent lifting |50-100# |25-50# |10-20# |

| |and/or carrying objects weighing up to 50 pounds. | | | |

| |Very Heavy: Ability to lift over 100 pounds with frequent lifting |Over 100# |Over 50# |Over 20# |

| |and/or carrying objects weighing over 50 pounds. | | | |

|List any other physical requirements or bona fide occupational qualifications:| |

Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.

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