Senior Compliance Specialist

About the role

As our Senior Compliance Specialist, you will support the CommonSpirit Health Corporate Responsibility Program by developing, implementing, and maintaining an effective and comprehensive compliance auditing and monitoring program. You will conduct and facilitate compliance audits for acute and non-acute care services, analyze outcomes, communicate findings, and contribute to ongoing auditing and monitoring efforts to ensure regulatory adherence.

Responsibilities

• Supports CRP leadership in developing, implementing, and maintaining the compliance monitoring/auditing work plan, with a primary focus on coding and medical necessity documentation guidelines.
• Determines monitoring/auditing procedures, including the use of computer-assisted audit techniques.
• Utilizes data analytics in conjunction with clinical services and other functional groups to develop and assess coding and clinical outlier risks.
• Monitors government recovery audit efforts for trends and patterns of non-compliance with billing, medical necessity, and coding issues affecting acute and non-acute care services.
• Works closely with Health Information Management (HIM), revenue cycle, legal services, advocacy, and other functional areas to ensure proper interpretation, dissemination, and ongoing internal auditing and monitoring of compliance with laws and regulations related to coding compliance and medical necessity.
• Supports leadership in developing, implementing, maintaining, and evaluating policies, procedures, tools, and templates to address changes in current laws and regulations related to coding compliance and medical necessity.
• Develops education to promote understanding of coding compliance and medical necessity issues, laws, regulations, and consequences of noncompliance.
• Analyzes reports, data, and trends to keep management and governance informed of the current regulatory environment impacting coding and medical necessity compliance and the potential impact to CommonSpirit Health.

Requirements

• Bachelor’s of Science in Nursing or equivalent experience may be considered in lieu of degree.
• 5 years of progressive experience in healthcare operations, including clinical, regulatory compliance, risk management, audit, law, or a related field.

Qualifications

• Certified Health Care Compliance (CHC)
• Registered Health Information Technician (RHIT)
• Registered Health Information Administrator (RHIA)
• Certified Coding Specialist - Physician Based (CCS-P)
• Certified Coding Specialist (CCS)

Where You'll Work

CommonSpirit Health is a nonprofit Catholic healthcare organization delivering more than 20 million patient encounters annually through over 2,300 clinics, care sites, and 137 hospital-based locations, along with home-based services and virtual care offerings. With more than 157,000 employees, 45,000 nurses, and 25,000 physicians and advanced practice providers across 24 states, CommonSpirit contributes over $4.2 billion annually in charity care, community benefits, and unreimbursed government programs.

Pay

$39.18 - $58.28 per hour