Compliance and Integrity Analyst
2 weeks ago
Employment Type:
Full time
Shift:
Day Shift
Overview:
This position is situated within the Integrity and Compliance division of Trinity Health Mid-Atlantic, focusing on the essential elements of a robust compliance framework.
The primary responsibilities encompass coding, auditing, monitoring, and educational initiatives related to professional services, necessitating a comprehensive understanding of the Medicare Physician Fee Schedule, Medicare Claims Processing Manual, National Correct Coding Initiatives, current procedural terminology, and International Classification of Diseases coding standards.
Position Objective:
Leverages specialized knowledge in professional coding, documentation, claims submission, and reimbursement policies as mandated by state and federal regulations to conduct audits and monitoring of health ministries.
Key duties include supporting scheduled work plan reviews and assisting in research, investigations, and defense activities in response to inquiries from regulatory bodies.
Facilitates the interpretation, dissemination, and education of Trinity Health Ministries regarding federal policy changes and other relevant regulatory updates.
Key Responsibilities:
Accountable for data collection, analysis, and reporting to aid the leadership team in achieving operational efficiency. Responsible for auditing departmental information, generating reports, and recommending process enhancements. Provides expertise in the program, services, and applications.
Core Functions:
- Conducts research, gathers, and analyzes information to identify opportunities, develop solutions, and lead resolution efforts.
- Collaborates on performance improvement initiatives based on outcomes related to program efficiency and patient experience.
- Distributes analytical reports to relevant stakeholders.
Process Management:
Utilizes various system applications to perform analyses, create reports, and develop educational materials. Demonstrates a foundational understanding of policies and practices to ensure quality, confidentiality, and safety are prioritized.
Data Management & Analysis:
Researches and compiles information to support operational projects and initiatives. Synthesizes and analyzes data, providing detailed summaries, including graphical presentations that illustrate trends and recommend practical solutions while considering business strategy impacts.
Regulatory Knowledge:
Maintains an up-to-date understanding of applicable federal, state, and local laws/regulations, as well as the Integrity & Compliance Program and Code of Conduct, ensuring adherence to ethical and professional standards.
Qualifications:
- Bachelor's degree or equivalent combination of education and experience.
- Experience in a healthcare organization or equivalent demonstrating knowledge of laws and regulations affecting the healthcare provider industry, particularly compliance programs.
- Certification in Healthcare Compliance ("CHC") or willingness to obtain certification within two years of hire.
- Preferred: Licensure or certification in compliance, law, audit, privacy, healthcare, or related fields.
- Experience with government audits and inquiries.
- Preferred: Master's or professional degree in law, business, or healthcare.
Compensation:
$46.88 per hour
Trinity Health Mid-Atlantic is committed to diversity and inclusion, ensuring equitable care for all communities served. We embrace diverse experiences and backgrounds, fostering an inclusive workforce.
Trinity Health Mid-Atlantic is an Equal Opportunity Employer, considering all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.
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