Senior Compliance Analyst (School of Dentistry)

Job Description

The Compliance Analyst-Senior will focus on supporting billing and coding compliance related activities for the School of Dentistry. This position will be responsible for the oversight and management of billing and coding investigations, auditing and monitoring initiatives, developing policies and procedures, completing compliance risk assessments, and developing risk-based educational materials to ensure compliance with federal/state laws and regulations, and UT Health San Antonio policies. Responsible for effectively communicating information and audit findings through presentations graphs, reports, and educational material.

Responsibilities

• Conduct regular internal audits of dental records, claims, and coding practices to ensure accuracy and compliance with federal and state regulations (e.g., HIPAA, False Claims Act, etc.). Prepare comprehensive audit reports with detailed findings and recommendations for corrective action.
• Analyze billing and coding data to identify trends, patterns, and outliers that may indicate compliance risks.
• Design and deliver engaging training programs for billing and coding staff that result in improved coding accuracy.
• Develop and implement strategies to improve coding accuracy and billing efficiency based on data analysis and or audit findings.
• Coordinates implementation of internal corrective action plans; monitors progress and completion; coordinates interviews and document gathering. Conducts re-audits to verify if corrective actions were fully implemented and effective.
• Assist with investigating dental billing compliance-related inquiries and complaints.
• Develops and prepares statistical reports and summations on compliance audit, review and investigation activities for submission to internal stakeholders. Track and regularly report compliance metrics.
• Stay abreast of industry best practices and regulatory changes to proactively identify dental billing and coding emerging risks.
• Assist with the development and implementation of compliance policies and procedures.
• Applies knowledge of federal and state statutes, laws, rules, and regulations related to dental billing, coding, and compliance practices to ensure accurate and compliant claim submissions.
• Demonstrates expertise in dental-specific coding systems (e.g., CDT, ADA codes) to ensure compliant billing practices.
• Performs all other duties as assigned.

Qualifications

• In-depth knowledge of federal and state statutes, laws, rules, and regulations affecting healthcare compliance practices.
• Critical thinking and sound analytical reasoning. Ability to work independently on recurring tasks with minimal supervision.
• Utilizes a high degree of self-direction by analyzing an issue, developing a plan to resolve it, and implementing the resolution.
• Strong organizational and time management skills required to multitask effectively and adapt to changing priorities and responsibilities under tight deadlines.
• Excellent customer service skills and strong willingness to take initiative.
• Strong verbal, written and interpersonal communication skills.
• Computer skills and proficiency in Microsoft Office programs including, but not limited to: Word, Excel, PowerPoint, Outlook, Access, and Power-BI or other widely available analytical, decision-making toolsets.

EDUCATION:

• Bachelor's degree required.
• Graduate-level degree preferred.

EXPERIENCE:

• Five (5) years prior healthcare compliance-related experience required.
• Experience in healthcare compliance-related audits/investigations preferred

LICENSE AND CERTIFICATION: