Job description

Minimum Qualifications: Bachelor’s degree and four (4) years of experience in an audit or investigation function preferred. Job Summary: To audit and/or review complex systems or operations in order to evaluate and report on compliance matters and the adequacy, effectiveness, and comprehensiveness of compliance, accounting, management, or other controls in these operations and to ensure compliance with applicable federal and state laws, rules, and regulations. Job Duties: Coordinates and conducts audits of compliance activities of UTMB departments for the Office of Institutional Compliance (OIC) to ensure compliance with applicable federal and state laws, rules, and regulations. Functional Specialty Responsibilities: (One or more of the following specialty areas may be assigned based on organizational need and employee expertise.) Conflict of Interest (COI): • Reviews and analyzes conflict of interest disclosures for compliance with institutional policies and applicable federal and state regulations. • Conducts assessments of potential financial, research, and professional conflicts of interest and recommends appropriate management strategies. • Coordinates with institutional stakeholders to develop, implement, and monitor conflict management plans. • Maintains documentation, tracking, and reporting related to COI disclosures, reviews, and resolutions. • Provides guidance and education to faculty, staff, and leadership regarding COI requirements and disclosure obligations. Compliance Risk Assessment: • Assists in the development, implementation, and maintenance of the institutional compliance risk assessment program. • Conducts enterprise and departmental compliance risk assessments to identify, evaluate, and prioritize regulatory and operational risks. • Analyzes data, trends, audit findings, and regulatory changes to identify emerging compliance risks and recommend mitigation strategies. • Collaborates with institutional leadership to develop corrective action plans and monitor remediation efforts. • Prepares risk assessment reports, dashboards, and presentations for leadership and compliance committees. Fraud & Abuse Hotline/Investigations: • Assists with the administration and coordination of compliance hotline and case management activities for the Office of Institutional Compliance. • Reviews and processes hotline reports and compliance concerns for documentation, tracking, routing, and follow-up. • Maintains case files, documentation, data entry, and related records in accordance with institutional standards and confidentiality requirements. • Coordinates meetings, communications, follow-ups, and status updates related to compliance reviews and case management activities. • Monitors case activity, supports timely follow-up, and assists with reporting, trend analysis, and process improvement initiatives. Billing and Coding Compliance: • Conducts billing compliance analytics and prepares reports to support risk-based work plans, including monitoring and reporting of audit findings, impact areas, and corrective actions taken. • Monitors and evaluates regulatory updates, payer guidance, and OIG Work Plan items to assess organizational impact and inform risk prioritization. • Collaborates with operational departments to support corrective action plans, education, and process improvement initiatives related to billing and coding compliance. • Utilizes compliance tools (e.g., MDaudit) to support risk assessment, trending, audit support, and compliance oversight activities. • Assists with analysis, trending, reporting, and maintenance of audit documentation related to billing and coding compliance activities. HIPAA/Privacy Compliance: • Assists with monitoring and reviewing compliance with HIPAA, privacy regulations, institutional privacy policies, and confidentiality requirements. • Reviews and processes privacy-related concerns, inquiries, and reported incidents for documentation, tracking, and follow-up. • Assists with privacy compliance reviews, monitoring activities, risk assessments, and related regulatory analyses. • Coordinates with operational departments, as appropriate, to support privacy compliance activities and corrective action efforts. • Assists in maintaining documentation, monitoring trends, and supporting privacy education and process improvement initiatives. Policy Management: • Assists with the review, coordination, tracking, and maintenance of institutional compliance-related policies and procedures to support alignment with regulatory requirements and organizational standards. • Supports policy management activities through document review, routing, follow-up communications, monitoring of review cycles, and coordination with departmental stakeholders. Marginal or Periodic Functions: • Adheres to internal controls and reporting structure. • Performs related duties as required. Knowledge/Skills/Abilities: • Advanced knowledge and understanding of compliance and industry processes, practices, and Regulations preferable. • Demonstrates commitment to continued education on compliance-related issues and relevant federal and state legal authority. • Experience with ethics, policies and procedures, training, investigations, audits, and compliance risk assessments and developing and managing compliance training and communication projects preferable. • Ability to identify legal risk and help strike a sensible and practical balance between legal risks and business goals. • Strong analytical reasoning skills to effectively and efficiently review, evaluate and analyze information and data. • Excellent collaborative skills, interpersonal skills, and written and oral communication skills. • Demonstrated commitment to a high level of integrity and ethical principles and professionalism to uphold the compliance culture, mission, and values of the institution. • Prior experience in a compliance-related area preferred. • Prior experience conducting audits and/or investigations preferred. • Goal-oriented and able to work independently once given direction. • Strong organizational skills. • Advanced knowledge of software application systems and spreadsheet reporting, and demonstrates eagerness and aptitude to quickly learn new software/programs. • Audits include compliance monitoring for the Office of Institutional Compliance, internal control, self-monitoring activities, internal education activities, investigational, and billing and coding audits with general supervision by the Chief Compliance Officer. • Perform specialized regulatory compliance review and analysis for the Office of Institutional Compliance. • Interacts with business administration department heads on a routine basis and establishes good working relations. • Keeps OIC attorneys and Executive Director(s) informed of audit progress, analysis results, and efficiently manages analysis and review so that departmental quality management standards are met. • Provides information or advice to the OIC attorneys and Executive Director(s) on regulatory compliance matters. • Formulates ideas and finds alternative solutions to problems and improves UTMB’s processes in ensuring the institution’s compliance with applicable state and federal laws, rules, and regulations. • Completes other job-related functions and special projects as assigned by the Chief Compliance Officer. Technical & Analytical Expertise: • Proficiency in Microsoft Excel, including complex formulas, pivot tables, and data modeling. • Experience with statistical and data analysis tools such as RAT-STATS, SAS, R, Python, SPSS, or similar platforms for data mining, modeling, and risk analysis. • Experience with data visualization and business intelligence tools to create impactful compliance dashboards and reports. • Knowledge of data governance, data validation, and data quality assurance practices. • Ability to work with large datasets from multiple systems, including electronic health records (EHR), billing systems, and compliance tracking tools. Salary Range: Actual salary commensurate with experience. Work Schedule: This position is remote within Texas only. Any candidate outside of the state of Texas must be willing to relocate. Occasional onsite presence required. Monday through Friday, 8 am to 5 pm and as needed on occasion. Equal Employment Opportunity UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities.

Requirements

Must-haves

Coordinates and conducts audits of compliance activities of UTMB departments for the Office of Institutional Compliance (OIC) to ensure compliance with applicable federal and state laws, rules, and regulations.
(One or more of the following specialty areas may be assigned based on organizational need and employee expertise.)
Reviews and analyzes conflict of interest disclosures for compliance with institutional policies and applicable federal and state regulations.
Conducts assessments of potential financial, research, and professional conflicts of interest and recommends appropriate management strategies.
Coordinates with institutional stakeholders to develop, implement, and monitor conflict management plans.
Maintains documentation, tracking, and reporting related to COI disclosures, reviews, and resolutions.
Provides guidance and education to faculty, staff, and leadership regarding COI requirements and disclosure obligations.
Assists in the development, implementation, and maintenance of the institutional compliance risk assessment program.
Conducts enterprise and departmental compliance risk assessments to identify, evaluate, and prioritize regulatory and operational risks.
Analyzes data, trends, audit findings, and regulatory changes to identify emerging compliance risks and recommend mitigation strategies.
Collaborates with institutional leadership to develop corrective action plans and monitor remediation efforts.
Prepares risk assessment reports, dashboards, and presentations for leadership and compliance committees.
Assists with the administration and coordination of compliance hotline and case management activities for the Office of Institutional Compliance.
Reviews and processes hotline reports and compliance concerns for documentation, tracking, routing, and follow-up.
Maintains case files, documentation, data entry, and related records in accordance with institutional standards and confidentiality requirements.
Coordinates meetings, communications, follow-ups, and status updates related to compliance reviews and case management activities.
Monitors case activity, supports timely follow-up, and assists with reporting, trend analysis, and process improvement initiatives.
Conducts billing compliance analytics and prepares reports to support risk-based work plans, including monitoring and reporting of audit findings, impact areas, and corrective actions taken.
Monitors and evaluates regulatory updates, payer guidance, and OIG Work Plan items to assess organizational impact and inform risk prioritization.
Collaborates with operational departments to support corrective action plans, education, and process improvement initiatives related to billing and coding compliance.
Utilizes compliance tools (e.g., MDaudit) to support risk assessment, trending, audit support, and compliance oversight activities.

Nice-to-haves

Bachelor’s degree and four (4) years of experience in an audit or investigation function preferred.
Prior experience in a compliance-related area preferred.
Prior experience conducting audits and/or investigations preferred.

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