Compliance Analyst - Office of Integrity & Compliance

Job Summary

To oversee and perform internal audits in an assigned area (Hospital, Provider, or Research) to ensure regulatory compliance in areas such as documentation, coding, billing, and research.

To educate providers and departmental staff on regulatory compliance guidelines, research regulations, and/or coding and billing requirements.

Responsibilities

• Performs audits on an assigned area (Hospital, Provider, or Research) and reports results to appropriate personnel.
• Participates in the development of educational and training programs that focus on elements of the compliance program;
• Explains compliance program guidelines, policies, and procedures to departmental staff and physicians.
• Analyzes operating procedures, identifies potential violations, and provides technical assistance/recommendations to management.
• Collaborates with managers to identify aberrant trends in the coding, billing, documentation, research, and other compliance areas, as applicable.
• Conferences with external auditors to ensure compliance of an assigned area.

Requirements

• Education and Experience Required: Degree (Bachelor's or Associate's) and three (3) years of ICD-9/ICD-10 coding, CPT coding, research, and/or billing experience.
• Certifications, Licenses, Or Registration Required: None.
• Preferred Qualifications: Certification from American Health Information Management Association (AHIMA), American Academy of Professional Coders (AAPC), Health Care Compliance Association (HCCA), Association of Clinical Research Professionals (ACRP), and/or Society of Clinical Research Professionals (SoCRA).

Knowledge, Skills & Abilities

• Knowledge of program/subject area (Hospital, Provider, or Research) statutory or regulatory provisions and administrative procedures.
• Knowledge of CPT, ICD-9 & ICD-10 coding principles and guidelines, billing rules, medical terminology, insurance plans, and/or research regulations.
• Verbal and written communication skills.
• Interpersonal skills to effectively interact with patients, clients, and other compliance staff members.
• Skill in applying regulatory guidelines to identify and solve problems.
• Skill in conducting compliance training.
• Skill in gathering and analyzing medical records and billing data and generating reports.
• Skill in presenting educational information.

Physical And Environmental Demands

• Requires occasional working hours significantly beyond regularly scheduled hours.
• Occasional traveling to offsite locations.
• Occasional activities subject to significant volume changes of a seasonal/clinical nature.
• Constant work produced subject to precise measures of quantity and quality.
• Occasional bending.
• Occasional lifting and carrying up to 50 pounds.
• Occasional crouching/stooping.
• Occasional driving.
• Constant sitting.
• Occasional standing.
• Occasional twisting.
• Occasional walking.

Pay

Salary: Not specified

Benefits

Benefits Eligibility: Not specified