Compliance Specialist

4 weeks ago

Manitowoc Wisconsin, United States Forefront Dermatology Full time
Overview:
The Compliance Specialist is a key member of the Compliance team and works closely with the VP of Compliance and Compliance Manager on projects associated with the facilitation and administration of compliance activities related to the operation of the Forefront Dermatology compliance program, including but not limited to general compliance activities, overseeing compliance investigations, and other projects as assigned.

Responsibilities:
General Compliance Duties

Assist with the development and implementation of compliance policies and procedures.

Review and evaluate company procedures and reports to identify hidden risks or common issues.

Perform audits of clinics and support services areas to assess compliance with regulatory requirements and identify areas for improvement.

Provide guidance and recommendations to stakeholders on compliance issues, regulatory requirements, and best practices.

Collaborate with associated business owners and clinical leaders to analyze medical records, billing documents, and other relevant documentation to identify discrepancies, fraudulent activities, or areas of non-compliance.

Provide back-up for Compliance Associate responsibilities, including but not limited to: LMS administration, background checks, monthly sanction screenings, monthly compliance and quality meeting preparation, etc.

Keep abreast of changes in health care laws, regulations, and industry standards to ensure investigations and compliance efforts remain current and effective.

 

Compliance Investigations

Conduct investigations of alleged violations of Forefront’s ethical standards or non-compliance with applicable laws, regulations, or company policy

Conduct interviews with relevant parties to gather information and evidence related to investigations.

Prepare detailed investigative reports documenting findings, conclusions, and recommendations for corrective actions as necessary.

Work with Compliance leadership and legal team on notifications to patients, payors, or regulators as required.

Design and monitor control systems to deal with violations of regulatory requirements and internal policies.

Conduct training sessions or workshops for health care professionals and staff members on compliance-related topics, ethical standards, and fraud prevention measures.

Perform other related duties as assigned.

Qualifications:
Bachelor’s degree in a healthcare related field or business preferred.

Minimum 3 years of experience in a similar compliance role.

CHC and/or CHPC certification preferred.

Juris Doctor is a plus.

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