Compliance Specialist | Corporate Compliance | Day | Full-Time

About the role

The Compliance Specialist will serve as an integral member of the Compliance Department, providing ongoing compliance monitoring and auditing functions. This includes reviewing regulatory, audit, billing, coding, documentation, medical necessity, and other general compliance processes to ensure appropriate reimbursement for the hospital and adherence to applicable laws, rules, guidelines, and regulations. The role involves providing compliance education and training, researching and responding to compliance inquiries, and following investigation protocols for reported or suspected non-compliance. The Specialist will also participate in compliance meetings and assist in developing and monitoring special compliance projects.

Responsibilities

• Serve as a strong role model for integrity, ethics, professionalism, objectivity, confidentiality, and compliance.
• Coordinate and conduct all aspects of Compliance & Privacy audits, including reviewing regulations, policies, procedures, and contracts; drafting audit plans; completing audits; and conducting meetings and interviews to evaluate compliance with healthcare laws, regulations, policies, procedures, contracts, or best practice guidelines.
• Monitor compliance reviews and activities conducted by various departments throughout the organization.
• Prepare complete, accurate, and thorough audit reports that identify potential deficiencies, risks, and issues.
• Work with stakeholders to develop and monitor corrective action plans related to compliance issues.
• Provide training on compliance and privacy programs and related topics for new and existing employees.
• Collaborate with other departments and stakeholders to ensure compliance across the organization.
• Support the organization's mission and compliance program through participation in meetings, task forces, committees, and special projects.
• Participate in developing and achieving the Compliance Department’s long-term and short-term objectives, risk assessments, policies, and procedures.
• Conduct regular audits and risk assessments to identify potential compliance gaps and vulnerabilities.
• Prepare and submit compliance reports as needed.
• Perform all other duties as assigned by management within job scope.

Requirements

• Associate’s degree in healthcare or business-related field preferred.
• 3 years of experience in Compliance, clinical, coding, auditing, legal, or related work with knowledge of healthcare laws and regulations governing hospitals and/or the healthcare industry required.