Corporate Responsibility Analyst/Educator - Hospital | St. Louis, MO | SSM Health

Corporate Responsibility Analyst/Educator - Hospital

GENERAL SUMMARY:  The Corporate Responsibility (CR) Analyst/Educator, under the supervision of the System Manager, Corporate Responsibility, is responsible for assisting in ongoing compliance auditing, monitoring, and education activities as indicated by the SSM Health CRP.  This position will assist in meeting appropriate regulatory standards related to hospital billing, reimbursement and third-party contractual arrangements.  This position will ensure that SSM Health employees (including providers) comply with internal policies, federal regulations, and third party requirements.  This position will compile and analyze statistics, audit coding and billing practices, and provide education to providers, coders and other employees to improve outcomes.  This position will ensure that proper coding methodology is used in accordance with relevant standards and will perform audits on a regular basis, both prospectively and in response to government and/or third party payer requests.




Reports to:   System Manager, Corporate Responsibility      


Supervises:  N/A


Interrelationships: Employees (including providers and billing/coding office staff), billing and coding office managers, and senior leaders of SSM assigned entities/regions; System Office employees and managers.  




1.    Imparts the philosophy, values, mission and vision of SSM Health and facilitates the integration of values in CQI activities.

2.    Understands, embraces and practices the principles of CQI in utilizing the Malcolm Baldrige criteria as a means to achieve performance excellence.

3.    Understands, embraces and models the SSM Health exceptional service standards.

4.    Provides a personal example of living the principles of continuous quality improvement whereby decision making is driven by data, and customer relationships are facilitated both within and outside the system.

5.    Researches, develops and presents educational modules regarding various hospital compliance, billing and coding issues to billing staff, coding staff, and providers.

6.    Assists with the development and maintenance of the SSM Health CRP, including compliance awareness education, implementation and maintenance of compliance policies and procedures, and monitoring of policy adherence and enforcement.

7.    Performs compliance investigations and presents recommendations to providers, and/or relevant committees.

8.    Coordinates and performs systematic internal audits of billing and reimbursement activities.

9.    Coordinates Physician Profiling Reviews, including the performance of medical record reviews at the request of insurance payers.

10. Documents and discusses detected deficiencies in billing and reimbursement with appropriate department leaders and provides recommendations to prevent future deficiencies.

11. Develops and maintains processes to monitor program effectiveness through audits, analysis of employee help-line reports, post office box inquires and other feedback mechanisms.

12. Remains current with government and third party billing regulations, government initiatives on fraud and abuse, and other related legislation (i.e. Stark II, Anti-kickback Statute, and HIPAA).

13. Researches and performs analysis of CR Work Plan(s) in assigned regions/entities.  Coordinates audits/record reviews and provides education to departments when necessary.

14. Serves as resource to all internal and external customers, answering questions, researching topics and providing information regarding coding, documentation and compliance issues.

15. Publishes monthly newsletter to provider staff regarding coding, documentation and compliance issues.

16. Participates on committees and work groups as required.

17. Participates in new provider orientations as requested.

18. Develops, implements and provides training for new (within 30 days of provider’s hire date) and existing providers to ensure compliance and to aid in understanding of documentation and coding guidelines.

19. Maintains credentialing certification.

20. Performs other related duties incidental to the work described herein and other special assignments by the System Manager or the System Director of Corporate Responsibility.

1.    Understanding the Mission and Values of SSM Health Care and the Franciscan Sisters of Mary.

2.    Bachelor’s degree in business or health care and one year relevant experience; OR an associate’s degree or high school diploma/equivalent with 2 years of additional schooling/training and three years relevant work experience

3.    Experience in analyzing, interpreting and communicating government, state and insurance health care regulatory standards related to billing; [e.g. credentialed as a  Registered Health Information Administrator (RHIA),  Certified Coding Specialist (CCS), Registered Health Information Technicians (RHIT), Certified Outpatient Coder (COC) or Certified Inpatient Coder (CIC) ]. 

4.    Proven capability to quickly build positive relationships and influence management and providers within assigned regions/entities.  Effective verbal and written communication skills, with the ability to communicate effective with all levels of management

5.    Experience in researching, interpreting, developing and presenting complex information using various instructional techniques. 

6.    Proven analytical and problem solving skills

7.    Travel to assigned regions/entities as required  


SSM Health - System Office –

SSM Health is one of the largest Catholic health systems in the country and is dedicated to quality and compassionate care for anyone in need, regardless of ability to pay. Based in St. Louis, where its System Office is located, SSM Health operates 20 hospitals in Wisconsin, Illinois, Missouri and Oklahoma. We provide care in various settings: outpatient sites, physician offices, a pharmacy benefit company, an insurance plan, hospitals, nursing homes, home care, hospice, telehealth and a technology company. Our Mission: Through our exceptional health care services, we reveal the healing presence of God.