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Regulatory Compliance Specialist
2 months ago
About Sound Inpatient Physicians:
Sound Inpatient Physicians is a national, multi-specialty medical group dedicated to delivering exceptional healthcare services. With a team of over 4,000 healthcare professionals, we are committed to ensuring patient-centered care across numerous facilities.
Position Summary:
The Compliance Analyst will operate under the guidance of the Senior Compliance Manager, focusing on research and analysis of extensive datasets to identify and mitigate risks related to fraud, waste, and abuse. This role will involve conducting evaluations across various service lines to ensure compliance with applicable federal and state regulations. The Compliance Analyst will also facilitate communication with other departments, such as Revenue Cycle Management and Legal, to support compliance efforts.
Key Responsibilities:
- Effectively communicate billing and documentation policies, ensuring clarity in ambiguous situations.
- Utilize analytical skills to assess compliance with relevant laws and standards.
- Conduct thorough research and respond to compliance inquiries, collaborating with the Senior Compliance Manager on risk assessments.
- Prepare and submit regulatory reports using the designated reporting tool.
- Evaluate potential fraudulent activities and develop tools for fraud detection.
- Audit medical records to identify discrepancies in coding and prepare comprehensive reports.
- Serve as a liaison between Central Service teams to facilitate effective communication.
- Monitor system outputs for accuracy and report discrepancies to management.
- Engage in problem resolution through analysis and troubleshooting.
- Manage projects effectively, providing regular updates to management on progress.
- Uphold confidentiality regarding protected health information, adhering to HIPAA policies.
Qualifications:
The ideal candidate will possess a blend of the following attributes, knowledge, and experience:
- Core Values: Coachable, resourceful, persistent, self-starter, strategic thinker, trustworthy, and customer-focused.
- Knowledge: High school diploma or GED, strong analytical and organizational skills, excellent communication abilities, understanding of auditing principles, and familiarity with coding standards (CPT and ICD 10).
- Experience: Minimum of one year in coding Evaluation and Management services and compliance investigations, along with recent exposure to revenue cycle or project management.
Sound Inpatient Physicians is an Equal Employment Opportunity employer committed to fostering diversity and inclusion within our workforce.
