Compliance Specialist

1 week ago


Englewood Colorado, United States CommonSpirit Health Full time
Job Summary

CommonSpirit Health is seeking a highly skilled Compliance Specialist to support the Corporate Responsibility Program (CRP) by developing, implementing, and maintaining an effective and comprehensive compliance monitoring program.

Key Responsibilities
  • Develop, implement, and maintain an effective and comprehensive compliance monitoring program.
  • Conduct and facilitate monitoring activities across CommonSpirit Health and analyze outcomes, communicate findings, and ensure follow-up on action plans as appropriate.
  • Operate in an independent and objective manner and maintain a high level of competency related to compliance with State and Federal laws and regulations.
  • Support the development, implementation, maintenance, completion, and reporting of the annual CRP Monitoring Plan.
  • Perform compliance monitoring as required to identify education opportunities and areas of potential risk.
  • Determine monitoring procedures to be used, including the use of computer-assisted audit techniques.
  • Obtain, analyze, and appraise evidentiary information as a basis for determining the adequacy and effectiveness of internal compliance controls.
  • Provide education to departments regarding audit findings, reimbursement impact, identified compliance issues, and risk mitigation, and recommend changes to improve processes, strengthen controls, and promote compliance.
  • Prepare and present monitoring reports and work with management to develop corrective action plans.
  • Keep management informed of any significant findings detected during an audit or monitoring project.
  • In collaboration with Corporate Responsibility Officers, assist with tracking follow-up with operations on development, implementation, and completion of action plans.
  • Maintain monitoring statistics for tracking and trending purposes.
  • Conduct reviews to include physician payments, business associate agreements, lease agreements, etc.
  • Participate in the Physician Transaction contracting process as assigned.
  • Participate in divestiture and acquisition projects as applicable.
Qualifications
  • Required Education and Experience:
    • Bachelor's 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.


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