Compliance Specialist | Corporate Compliance | Day | Full-Time

Overview

The Compliance Specialist will serve as an integral member of the Compliance Department The Compliance Specialist will provide ongoing compliance monitoring and auditing functions to include review of regulatory, audit, billing, coding, documentation, medical necessity and other general compliance processes and analyses that result in appropriate reimbursement for the hospital and adherence to applicable laws, rules, guidelines and regulations. Provides ongoing compliance education and training. Researches and responds to compliance inquiries. Follows investigation protocols and responds to reported, suspected, or confirmed non-compliance. Participates in and attends compliance meetings that foster open lines of communication within the organization. Assists in the development and monitoring of special compliance projects with Compliance Managers and members of hospital departments. Provides compliance advice and guidance.

Responsibilities

• Serves as a strong role model for integrity, ethics, professionalism, objectivity, confidentiality, and compliance.
• Coordinates and conducts all aspects of Compliance & Privacy audits, to include reviewing regulations, policies and procedures, and contracts; drafting audit plans; completing audits; and conducting meetings and interviews for the purpose of evaluating whether the organization's processes and practices comply with healthcare laws, regulations, policies, procedures, contracts, or best practice guidelines. Monitors compliance reviews and activities being conducted by the various departments throughout organization.
• Preparing complete, accurate, and thorough audit reports that identify potential deficiencies, risks, and issues.
• Working with stakeholders throughout the organization to develop and monitor corrective action plans related to compliance issues.
• Provide training on the compliance and privacy programs and compliance and privacy related topics for new and existing employees.
• Work with other departments and stakeholders to ensure compliance across the organization.
• Supports the organization's mission/compliance program through participation in meetings, task forces, committees, and special projects.
• Participates in developing and achieving the Compliance Department's long-term and short-term objectives, risk assessments, policies, and procedures.
• Conduct regular audits and risk assessments to identify potential compliance gaps and vulnerabilities.
• Prepare and submit compliance reports, as needed.
• Perform all other duties as assigned by management within job scope

Qualifications

Education:

Associates degree in healthcare or business related preferred.

Experience:

• 3 years Compliance, clinical, coding, auditing, legal, or related work experience with knowledge of and experience with healthcare laws and regulations that govern hospitals and/or the health care industry required