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Compliance Analyst

Location: Pittsburgh, PA

Cardiac Management Solutions

The Cardiac Management Solutions division of ZOLL Medical Corporation develops products to protect and manage cardiac patients, including the LifeVest® wearable cardioverter defibrillator (WCD), the ZOLL cardiac monitor, and associated technologies.

Heart disease is the leading cause of death for both men and women in the U.S. At ZOLL, your work will help to ensure cardiac patients get the life-saving therapy they need. To date, the LifeVest WCD has been worn by hundreds of thousands of patients and saved thousands of lives.

ZOLL has been Pittsburgh’s Manufacturer of the Year, one of Western PA’s Healthiest Employers, and even one of Pittsburgh’s Coolest Offices. But it’s our unique opportunity to impact people’s lives that makes ZOLL the ideal place to build your career.

Position Summary:  The Compliance Analyst is an integral member of the reimbursement team and has primary responsibility to ensure compliance with all Centers for Medicare & Medicaid federal regulatory requirements.  This is achieved by performing quarterly claims audits, responding to payor audits and Medicare appeals, identifying internal areas for improvement, review of patient accounts and interpreting CMS requirements.                  

Essential Duties and Responsibilities:

  • Review patient accounts to ensure medical necessity has been met as per payor contracts as well as confirm correct diagnosis codes have been assigned to ensure accurate billing 
  • Obtain necessary documentation (updated medical order, clinical notes, patient agreement, etc.) in preparation for audit/appeal responses
  • Maintain contact with patient, physician office, and sales field to relay and/or obtain pertinent information and/or documents
  • Tracking / Monitoring audit activity to summarize and communicate regular audit updates to senior / executive management
  • Quality evaluation of select claims to determine deficiencies; present findings and recommendations to executive management
  • Identifies and resolves problems in a timely manner; gathers and analyzes information skillfully; utilizes available tools and resources effectively
  • Develop and deliver training programs and presentations to staff and providers as directed
  • Produces work with attention to detail to reduce typos and inaccuracies that can occur in a fast paced setting
  • Ability to handle multiple tasks simultaneously under strict deadlines 
  • Performs other duties as assigned by Management

Supervisory Responsibilities:  None

Qualifications:  To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skills and abilities required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this job. 

Educations and/or Experience:

  • H.S. Diploma or equivalent required, Associate’s or Bachelor’s degree in nursing, business, finance or related field preferred
  • 3-5 years’ experience in medical billing, coding and/or insurance verification
  • Superior oral and written communication and customer service skill
  • Experience in provider appeals with all payer types
  • Proficiency in MS Office Suite                                                                                                                                               

Language Skills:  Ability to read and comprehend complex instructions, correspondence, and memos.  Ability to write complex correspondence.  Ability to effectively present information in one-on-one, small and large group situations to customers, clients, and other employees of the organization. 

Mathematical Skills:  Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.  

Reasoning Ability:  Ability to apply understanding of medical terminology to carry out instructions furnished in written, oral, or diagram form.  Ability to exhibits sound and accurate judgment to make appropriate decisions to insure the correct outcome. 

Computer Skills:  To perform this job successfully, an individual should be proficient in Microsoft Office Suite.

Physical Demands:

  • The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  •  While performing the duties of this job, the employee is frequently required to sit, walk, talk and hear.  Employee may occasionally be required to lift and carry up to 25 pounds.

Work Environment:

  • The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • The noise level in the work environment is usually quiet.

 

Equal Opportunity Employer-Disability and Veteran

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