JOB SUMMARY: Under general direction designs and executes the annual compliance audit plan for the hospital and specialty clinics consistent with the annual compliance plan, placing particular emphasis on the revenue cycle and other high riskfinancial and operational risk areas to identify existing and potential compliance issues and to directly support compliance with applicable ethical standards, laws, regulations, rules, policies, procedures, and professional practice standards.
Analyzes and audits revenue cycle work processes, internal controls, policies, and procedures for organizational, regulatory, and third party payer compliance. Schedules, plans, drafts scopes of work, and coordinate resources for internal compliance audits and external contract compliance audits.
Coordinates and performs compliance analysis and auditing activities for the hospital and specialty clinics in accordance with generally accepted auditing practices. Utilizes approved standard model format to analyze and record sufficient, reliable information to identify audit objectives and scope upfront, and ensure appropriate analyses and evaluation of findings to support conclusions.
Prepares written findings, recommendations, and corrective action plans. Shares relevant information with Compliance & Privacy Officer and operational stakeholders. Refers issues that may involve non-compliance, misconduct, voluntary disclosures, and/or refunds to the Compliance & Privacy Officer.
Monitors corrective action plans for management accountability. Track and trend compliance analysis and auditing activities in compliance database system. Prepares oral and written compliance analysis and auditreports.
Collaborates with organizational stakeholders to identify and evaluate opportunities to mitigate risks and trends for compliance of revenue cycle activities with industry standards and regulatory/payer guidance on issues such as medical necessity, accurate and complete health record documentation, coding, data and charge entry, billing and claims management
Drafts compliance analysis and audit departmental policies and procedures. Provides sound advice, consultation, and feedback on revenue cycle compliance issues. Participates in revenue cycle committees. Monitors and reviews trends in compliance analysis and audit programs.
Makes recommendations for continuous program improvements consistent with HHS Office of Inspector General Compliance Guidance, U.S. Sentencing Commission, False Claims Act, State of Alaska, Joint Commission, and others applicable regulatory and accreditation agencies.
Serves as compliance analyst, audit liaison and collaborates with internal/external customers, internal/external auditors, business partners, committees, consultants, federal/state agency staff, contractors, and fiscal intermediaries.
Performs other duties as assigned.
KNOWLEDGE and SKILLS
Knowledge of compliance investigation procedures.
Knowledge of compliance analysis and auditing practices.
Knowledge of applicable federal/state laws and regulations, and other operational guidelines and directives.
Knowledge of professional practice standards for health care organization revenue cycle activities.
Skill in oral and written communication.
Skill in analyses and problem solving.
Skill in interpreting and applying ethical standards.
Skill in applying effective education and training techniques.
Skill in reading and interpreting financial reports and legal documents.
Skill in developing and conducting effective presentations to audiences.
Skill in analyzing and evaluating accounting and internal control methods and procedures.
Skill in interpreting and applying laws, rules and regulations relating to regulatory compliance.
Skill in operating a personal computer using a variety of software applications.
Skill in project management and assessing and prioritizing multiple tasks, projects and demands.
MINIMUM EDUCATION QUALIFICATION FOR COMPLIANCE ANALYST POSITION
A Bachelor’s degree in business, health, public health, administration, Nursing, Health Information, or related field. Progressively responsible professional/exempt work experience may be substituted on a year-for-year basis for college education.
MINIMUM EDUCATION QUALIFICATION FOR COMPLIANCE SPECIALIST POSITION
A Bachelor's degree, preferably in ethics, public administration, regulatory affairs, business, health, public health, social services, business, administration, or a related field. Progressively responsible professional work-related experience, education, or training may be substituted on a year-for-year basis for college education.
MINIMUM EXPERIENCE QUALIFICATION FOR COMPLIANCE ANALYST POSITION
Non-supervisory - Seven (7) years of experience in a health organization setting.
Inclusive of - Five (5) years experience analyzing and auditing health care revenue cycle and other financial and operational activities. An equivalent combination of relevant education and/or training may be substituted for experience.
MINIMUM EXPERIENCE QUALIFICATION FOR COMPLIANCE SPECIALIST POSITION
Non-supervisory - Three (3) years of demonstrated experience in ethics and compliance work or similar field.
MINIMUM CERTIFICATION QUALIFICATION FOR COMPLIANCE ANALYST POSITION
Current registered nurse license in the State of Alaska.
Or Certification in coding (CCS, CCS-P, CPC and CPC-H).
MINIMUM CERTIFICATION QUALIFICATION FOR COMPLIANCE SPECIALIST POSITION
Must have or obtain Certified Healthcare Compliance (CHC) certification within one (1) year of hire.
PREFERRED EDUCATION QUALIFICATION
PREFERRED EXPERIENCE QUALIFICATION
PREFERRED CERTIFICATION QUALIFICATION
Certification in health care compliance.
The following demands are representative of those that must be met by an employee to successfully perform the essential functions of this job:
Must be able to lift approximately 10 pounds.
May be required to work outside the traditional work schedule.
May be called out to work off-shift in emergency situations.
Job Location Anchorage, Alaska, United States Position Type Full-Time/Regular
Tracking Code 20182222