Compliance Consultant

About the role

This position plans, administers, maintains, and coordinates compliance processes, policies, and procedures as well as applicable laws and regulations for the organization. The Consultant documents regulatory research and guidance, designs and executes risk assessments, develops audits and monitoring techniques, designs and executes training and education, and assists leadership in process improvement to ensure compliance with laws and regulations. Coordinates efforts with Managers of Internal Audit, Information Security, and Enrollment.

Responsibilities

• Reviews a wide variety of organization policies and procedures to ensure compliance with legal, accreditation, and internal standards.
• Analyzes existing policies, identifies gaps, and recommends new or revised standards, approval processes, and monitoring methods for departmental use.
• Reviews detailed departmental processes and policies, noting deficiencies.
• Researches and develops materials for educational programs related to all aspects of compliance, including federal guidelines and responses to investigations.
• Designs and executes risk assessments to analyze the effectiveness of the Compliance Program, identifying areas for improvement. Develops monitoring plans to determine adherence to action plans. Prioritizes issues based on organizational exposure.
• Receives quarterly reports on the status of risk monitoring, analyzes reported results, identifies trends, and develops corrective actions where appropriate.
• Manages the process of investigation and response to issues identified by the Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), Zone Program Integrity Contractor (Z-PIC), or Medicaid Integrity Contractor (MIC). Collaborates with Health Information Services, Patient Financial Services, and/or Care Management to monitor and track results and the need for Performance Improvement Action Plans.
• Audits potential issues before they are identified by regulatory auditors.
• Investigates allegations, facilitates remediation of gaps, and escalates critical issues to management, administration, and leadership through to resolution. Prepares written narratives of findings, assigns and assesses action plans, and follows up to ensure compliance.
• Designs and executes compliance audits throughout the organization. Verifies compliance or noncompliance issues against established policies, procedures, and applicable laws. Facilitates remediation of noncompliance and escalates critical issues as needed. Audits may focus on documentation, billing, coding, medical necessity, and reimbursement.
• Develops recommendations for corrective action based on review findings and works with service/process administrators and department management to refine recommendations. Develops presentations for leadership on assessment results.
• Performs quality and process improvements. Develops, recommends, and assists with process creation and structure standards regarding compliance. Establishes guidelines and procedures to enhance customer service; plans and conducts meetings to ensure compliance with established procedures.
• Assists leaders in compliance process design and implementation of new policies.
• Evaluates new and existing legislation and regulatory guidelines, disseminates education to impacted caregivers and leadership to ensure future compliance. Assists leadership with the development of regulations, materials, and resources used to educate caregivers on compliance program objectives.
• Performs a variety of administrative duties with latitude for exercising discretion and judgment, including receiving and answering correspondence, arranging and scheduling appointments, and supervising the preparation of materials for meetings.
• Receives confidential questions or concerns from caregivers concerning compliance situations. Investigates questions or concerns received via email, voicemail, "hotline," or drop-ins, determines specifics, and provides recommendations for resolution or refers concerns to appropriate individuals for follow-up.
• Rounds on customers to determine their needs.
• Other duties as assigned.

Requirements

• Bachelor's Degree from an accredited college or university or an equivalent combination of education and/or experience.
• Proficiency in Microsoft Word, Excel, Access, and PowerPoint.
• 5 years of coding/billing experience in the healthcare industry, with specific experience typically obtained as a coder, consultant, and/or auditor (preferred).
• Prior experience performing physician coding audits or experience working with physicians to correct coding and documentation issues with demonstrated success (preferred).
• Travel to off-site locations may be required.

Qualifications

• Certified Professional Coder (CPC) – preferred within 1 year.
• Certified Coding Specialist-Physician-based (CCS-P) – preferred within 1 year.
• Registered Health Information Technician (RHIT) – preferred within 1 year.
• Registered Health Information Administrator (RHIA) – preferred within 1 year.

Skills

• Essential Technical/Motor Skills: Input data, type, manipulate calculator and small business equipment, speak clearly and professionally, answer telephone, copying.
• Interpersonal Skills:
  • Demonstrated ability and self-confidence to work independently with minimal supervision.
  • Ability and desire to work with administrators, leadership, providers, and caregivers to achieve consensus, resolve inquiries, complaints, and concerns.
  • Ability to maintain objectivity and independence when working with caregivers, leadership, and providers.
  • Advanced research skills, including the ability to locate, interpret, and provide guidance on regulations, laws, legal documents, coding and billing guidelines, and contracts.
  • Analytical, organizational, problem-solving, decision-making, listening, negotiating, mentoring, and influencing skills.
  • Ability to plan and execute multiple projects simultaneously.
  • Demonstrated effective inter- and intrapersonal people skills.
  • Good project management skills to implement compliance and privacy initiatives, including project planning, scheduling, oversight, and implementation in accordance with target completion dates.
  • Ability to communicate via written or small and large group presentations.
  • Excellent oral and written communication skills; ability to present a positive image for the organization.
  • Motivated, able to work independently, strong facilitator, and excellent follow-through skills.
  • Ability to interact with people in a professional, diplomatic, and sensitive manner while ensuring appropriate confidentiality is maintained.
  • Communicate effectively, both verbally and in writing, with all levels of staff, leadership, the public, and agency representatives.
• Essential Physical Requirements: Lifting, moving, reaching, bending, stooping, standing, walking, reading, typing, operating small business equipment.
• Essential Mental Abilities: Independent thinking and in-depth analysis skills. Ability to analyze, synthesize, evaluate, comprehend, explain, understand, forecast, interpret, and manipulate data.
• Essential Sensory Requirements: Exposure to hazards.

Benefits

Mosaic Life Care offers a wide array of benefits to meet individual employee needs, including concierge services, an employee lounge, wellness programs, free covered parking, free on-site and virtual health clinics, and many more. Benefits are designed to ensure employees feel valued and supported at every stage of their journey.