Compliance Analyst

J  o  b    D  e  s  c  r  i  p  t  i  o  n

JOB INFORMATION

Effective Date:

6/23/2026

Entity:

Wisconsin

Job Code:

310019

Job Title:

Compliance Analyst

FLSA Exemption Status:

Exempt

Management Level:

Individual Contributor

JOB SUMMARY

Under the general supervision of the Compliance Audit Manager, the Compliance Analyst is responsible for reviewing the documentation and billing of UW Health to ensure compliance with governmental and third-party payer regulations.  This position collaborates with physicians and internal staff in development of improved capabilities in the areas of documentation, coding and compliance while promoting Compliance initiatives with clinical faculty and administration.

ESSENTIAL DUTIES

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Responsible for compliance audits of billing providers within UW Health including joint ventures and affiliates across multiple specialties. Obtain and review medical records and other documentation to audit and ensure compliance.

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Identify coding and billing risk areas, conduct focused reviews and implement corrective action as needed. Ensure accurate coding by utilizing official coding resources, Medicare and Medicaid manuals and policies and third-party payer resources

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Meet with the individual physicians, coders, and departments to present findings. Educate providers regarding compliance with the Center for Medicare and Medicaid guidelines as they pertain to an academic medical center, fraud and abuse guidelines as well as official coding rules.

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Review internal controls, policies and procedures to ensure compliance with appropriate University, State and Federal guidelines and policies, sound business and finance practices, and overall clinical goals and objectives.

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Interpret applicable laws and regulations concerning Compliance, Fraud and Abuse and educate appropriate personnel.

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Respond promptly to external and internal concerns; implementing corrective actions as appropriate. Communicate with Medicare/Medicaid Carriers and third-party payers regarding policies and procedures.

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Perform continuous evaluation of the audit program including, but not limited to recommending changes or improvement to achieve audit efficiencies and recommending and developing standards to be utilized in the audit process

As needed, additional responsibilities reasonably within the scope of duties and physical requirements may be assigned.  ALL DUTIES AND REQUIREMENTS MUST BE PERFORMED CONSISTENT WITH THE UW HEALTH PERFORMANCE STANDARDS AND RESPECT FOR PEOPLE COMMITTMENTS.

X

Non-Clinical

JOB REQUIREMENTS

Graduate of a Medical Coding Program
Two years of Coding experience may be considered in lieu of the medical coding program, in addition to the experience below.

Required

High School diploma or equivalent

Preferred

Bachelor's Degree

in a health care related field

Preferred

3 years

of related coding or auditing experience in a health care setting

Required

Experience with third-party reimbursement and billing systems

Required

5 years

 multi-specialty physician/hospital coding experience in an academic medical center

Preferred

Experience interacting with physicians/hospital staff regarding coding requirements

Preferred

Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC), Certified Outpatient Coder (COC), or Certified Professional Medical Auditor (CPMA)

Required

LICENSE, CERTIFICATIONS, AND REGISTRATIONS MUST BE MAINTAINED PER UW HEALTH POLICY. 

•

In depth knowledge of coding process, coding software systems, and electronic medical records

•

Excellent written and oral communication skills

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Experience with word processing, spreadsheets and database software

•

In depth knowledge of Official Coding and Clinical Documentation Guidelines

•

Strong working knowledge of medical terminology

•

Proven knowledge of CPT and ICD-10 coding

•

Strong understanding of locating and using Medicare rules and regulations

•

Ability to analyze, research and problem solve complex issues

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

☒

Sedentary: Sedentary work involves lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files, 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 occasionally and other sedentary criteria are met.

Up to 10#

Negligible

Negligible

☐

Light: Light work involves lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds. Even though the weight lifted may be very little, a job is in this category when it requires a good deal of walking or standing, or when it involves sitting most of the time with some pushing and pulling of arm or leg controls. To be considered capable of performing a full or wide range of light work, you must have the ability to do substantially all of these activities. If someone can do light work, we determine that they can also do sedentary work, unless there are additional limiting factors such as loss of fine dexterity or inability to sit for long periods of time.

up to 20#

Up to 10# or requires significant walking or standing or requires pushing/pulling of arm/leg controls.

Negligible or constant push/pull of items of negligible weight

☐

Medium: Medium work involves lifting no more than 50 pounds at a time with frequent lifting or carrying of objects weighing up to 25 pounds. If someone can do medium work, we determine that they can also do sedentary and light work.

20-50#

10-25#

Negligible-10#

☐

Heavy: Heavy work involves lifting no more than 100 pounds at a time with frequent lifting or carrying of objects weighing up to 50 pounds. If someone can do heavy work, we determine that they can also do medium, light, and sedentary work.

50-100#

25-50#

10-20#

☐

Very Heavy: Very heavy work involves lifting objects weighing more than 100 pounds at a time with frequent lifting or carrying of objects weighing 50 pounds or more. If someone can do very heavy work, we determine that they can also do heavy, medium, light, and sedentary work.

Over 100#

Over 50#

Over 20#

Other - list any other physical requirements or bona fide occupational qualifications not indicated above:

Over 50 lbs.

UW Health does not require, nor does it expect that its employees lift more than 50 lbs unassisted. Objects in excess of 50 lbs should be lifted or moved with mechanical means or through a team lift. Employees in patient care areas are expected to utilize mechanical lifts and adhere to the "Use of Mechanical Lifts (Liko)" policy in the Patient Services Policy and Procedure Manual.

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.

THE EMPLOYEE MUST BE ABLE TO COMPLETE ALL PHYSICAL REQUIREMENTS OF THE JOB WITH OR WITHOUT AN APPROVED ACCOMODATION. 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.