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Compliance Specialist

2 months ago

Englewood, United States CommonSpirit Health Full time

Overview:

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.

Responsibilities:

JOB SUMMARY / PURPOSE
Supports the Corporate Responsibility Program (CRP) by developing, implementing, and maintaining an effective and comprehensive compliance monitoring program. Conducts and facilitates monitoring activities across CommonSpirit Health and analyzes outcomes, communicates findings, and ensures follow-up on action plans as appropriate. Operates in an independent and objective manner and maintains a high level of competency related to compliance with State and Federal laws and regulations.

ESSENTIAL KEY JOB RESPONSIBILITIES

  • Supports the development, implementation, maintenance, completion and reporting of the annual CRP Monitoring Plan.
  • Performs compliance monitoring as required to identify education opportunities and areas of potential risk. Monitoring may include but is not limited to coding, medical documentation, privacy and general CRP compliance.
  • Determines monitoring procedures to be used, including the use of computer-assisted audit techniques.
  • Obtains, analyzes, and appraises evidentiary information as a basis for determining the adequacy and effectiveness of internal compliance controls.
  • Provides education to departments regarding audit findings, reimbursement impact, identified compliance issues and risk mitigation, and recommends changes to improve processes, strengthen controls, and promote compliance.
  • Prepares and presents monitoring reports and works with management to develop corrective action plans.
  • Keeps management informed of any significant findings detected during an audit or monitoring project.
  • In collaboration with Corporate Responsibility Officers, assists with tracking follow up with operations on development, implementation and completion of action plans.
  • Maintains monitoring statistics for tracking and trending purposes.
  • Conducts reviews to include physician payments, business associate agreements, lease agreements, etc.
  • Participates in the Physician Transaction contracting process as assigned
  • Participates in divestiture and acquisition projects as applicable


Qualifications:

Required Education and Experience

  • Bachelors degree equivalent education/experience may be considered in lieu of degree.
  • Minimum 3 years of experience in contracts auditing and monitoring.

Required Licensure and Certifications

  • One of the following is preferred upon hire or required within first year of employment: Certification in Healthcare Compliance (CHC), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Health Professional (CHP), Certified Coding Specialist - Physician-based (CCS-P), Certified Coding Specialist
    (CCS), Certified Prof. Coder through AAPC (CPC), Certified Public Accountant (CPA), Registered Nurse (RN), Bachelors of Science in Nursing (BSN).

Required Minimum Knowledge, Skills, Abilities and Training

  • Knowledge of federal and state laws and regulations regarding physician self-referral and fraud and abuse
  • Ability to work independently to manage multiple projects simultaneously
  • In depth knowledge of healthcare regulations and guidance relative to assigned subject matter area (acute, physician enterprise, post-acute, physician
    contracting, etc.)
  • Ability to research regulations and guidance for interpretive purposes
  • Ability to analyze data, identify and summarize trends.
  • Excellent written communication skills
  • Language, Math, Reasoning, Computer skills

While youre busy impacting the healthcare industry, well take care of you with benefits that include health/dental/vision, FSA, matching retirement plans, paid vacation, adoption assistance, annual bonus eligibility and more

#L-CSH

#Healthcare Compliance, CHC, RHIT, CCS, CPC, CPA, CCS-P, APC CHP, RHIA, RN