Compliance Analyst

3 weeks ago

Roanoke, United States 10046 Sound Inpatient Phys Inc (SIP) Full time
Job DescriptionJob Description

About Sound:

Headquartered in Tacoma, WA, Sound Physicians is a physician-founded and led, national, multi-specialty medical group made up of more than 1,000 business colleagues and 4,000 physicians, APPs, CRNAs, and nurses practicing in 400-plus hospitals across 45 states. Founded in 2001, and with specialties in emergency and hospital medicine, critical care, anesthesia, and telemedicine, Sound has a reputation for innovating and leading through an ever-changing healthcare landscape — with patients at the center of the universe.

Sound Physicians offers a competitive benefits package inclusive of the items below, and more:

  • Medical insurance, Dental insurance, and Vision insurance
  • Health care and dependent care flexible spending account
  • 401(k) retirement savings plan with a company match
  • Paid time off (PTO) begins accruing immediately upon start date at a rate of 15 days per year, in accordance with Sound's PTO policy
  • Ten company-paid holidays per year  

About the Role:

The Compliance Analyst will work under the direct supervision of the Senior Manager of Compliance, primarily to conduct research and analyze large datasets from various sources to prevent potential fraud, waste, and abuse. The Compliance Analyst will conduct reviews and assessments across multiple services lines to ensure adherence to state and federal regulations. This position will work as a liaison to assist in communicating with other Central Services departments such as Revenue Cycle Management and Legal. This role serves as a Sound remote colleague liaison for helping to mitigate risk—such as inappropriate disclosure of PHI and/or other HIPAA violations—along with responding to regulators and communicating with vendors. This position is both a client-facing position and an internal colleague-facing position. Sound Physicians contracts with over 250 individual hospitals.

This position functions to ensure compliance with Federal and State laws, and to ensure that Sound functions within the confines of each Business Associate Agreement (BAA), meeting all contractual and regulatory obligations.

The Details: This is a remote position.

In this role, you will be responsible for:

  • Demonstrating the ability to communicate effectively regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific information
  • Using relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards
  • Absorbing information and forming general rules or conclusions (including finding relationships among seemingly unrelated events) and applies general rules to specific problems to produce answers that make sense
  • Researching and responding to compliance inquiries, working closely with the Senior Manager of Compliance on Risk Assessments
  • Filing regulatory reports and other documentation using our reporting tool, Navex
  • Reviewing and assessing potential fraud activity and developing fraud detection tools
  • Auditing medical record documentation to identify coding variances; preparing reports of findings; creating a plan for next steps
  • Acting as a liaison and/or facilitating communication with other Central Service teams
  • Maintaining clear and consistent communication
  • Monitoring system outputs for integrity and error identification and reporting all errors to management
  • Performing problem resolution, including analysis and troubleshooting
  • Project Management skills required to maintain organization and report out weekly to management on the status of current projects
  • Maintaining strict confidentiality about protected health information. Understanding and adhereing to Sound’s HIPAA Privacy & Security policies and procedures

What we are looking for: A successful candidate will have a demonstrated track record of a combination of these values, knowledge, and experience:

Values:

  • Coachable - Demonstrates a willingness to accept feedback from others and put it into practice
  • Resourceful - Proactive willingness to utilize available information and tools to figure things out
  • Persistent - Demonstrates the ability to “keep at it” even when obstacles or challenges are present; returns to the work at hand after a change of course
  • Self-Starter - Demonstrates the ability to jump in and start a task or project with limited direction
  • Strategic Thinker - Demonstrates the ability to look at the big picture and proactively develop a plan of action
  • Trustworthy - Demonstrates a high degree of integrity; keeps confidences; does what they say they will do
  • Customer Focused - Puts customer (internal and external) needs first and makes customers their top priority

Knowledge:

  • High school Diploma or GED certificate
  • Ability to clearly communicate medical coding information
  • Knowledge of auditing concepts and principles
  • Knowledge and understanding of professional fee coding (CPT and ICD 10), physician group practice revenue cycle processes, regulatory compliance issues related to billing and coding, documentation standards, and third-party payer processes
  • Ability to use independent judgment and to manage and impart confidential information
  • Ability to adapt, modify and prioritize audit functions as required
  • Coding Certification required (Any of CPC, CPC-H, CCS, CCS-P)

Experience:

  • 1 year of experience coding Evaluation and Management services
  • 1 year experience with compliance investigations
  • Recent experience with revenue cycle or project management

Sound Physicians is an Equal Employment Opportunity (EEO) employer and is committed to diversity, equity, and inclusion at the bedside and in our workforce. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, gender identity, sexual orientation, age, marital status, veteran status, disability status, or any other characteristic protected by federal, state, or local laws.

This job description reflects the present requirements of the position.  As duties and responsibilities change and develop, the job description will be reviewed and subject to amendment. 

#ZR

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