Compliance Specialist, Senior

Reporting to the Compliance Director, the Compliance Specialist, Senior works within the Compliance Office and collaborates with the Revenue Cycle, Quality, Pharmacy, Laboratory and other partners across the enterprise to ensure compliance with applicable laws, regulations and enterprise policies. The Compliance Specialist, Senior, will plan and conduct compliance audits and serve as a content expert for health care reimbursement/billing compliance activities within the Compliance Office; respond to inquiries, investigate complaints, prepare audit reports, develop and deliver education and outreach, report on program activities, maintain program records, and monitor regulatory developments; and assist with the creation and review of policies and procedures. Working with both internal and external stakeholders, the Compliance Specialist, Senior, helps establish and maintain a health care reimbursement/billing compliance risk assessment, auditing and reporting program.

At Fred Hutchinson Cancer Center, all employees are expected to demonstrate a commitment to our values of collaboration, compassion, determination, excellence, innovation, integrity, and respect.

• Assist the Compliance Office inexecuting an effective auditing and monitoring plan by conducting independent and integrated compliance audits and investigations.
• Receive and respond to generated inquiries, requests for consultation, and complaints.
• Prepare written reports of audit findings/results, including recommendations for improvement and corrective actions (e.g. refund identified overpayments).
• Assist in tracking and conducting health care reimbursement compliance risk assessments, identify high risk areas and communicate results to Senior Manager, Health Care Reimbursement Compliance.
• Assist in the development, implementation and maintenance of clinical and research reimbursement and coding compliance education, training and internal controls (i.e. policies and procedures).
• Develop standard compliance reports to communicate findings and call attention to trends. Provide reports on these activities to the Senior Manager for further distribution as needed.
• Maintain working knowledge in current health care compliance issues, OIG enforcement activities, and other applicable regulations such as HIPAA, licensure requirements, and quality standards.
• Perform other duties as may be assigned.

Required:

• Bachelor's degree.
• Minimum five years of experience related to health care reimbursement/ coding operations or compliance including experience conducting internal audits or hospital billing and coding audits and written reports of findings.
• Extensive knowledge of ICD-9-CM, ICD-10-CM, CPT, and HCPCS coding principles and guidelines.
• Strong critical thinking and data analysis abilities including the ability to gather information from multiple sources, including but not limited to sophisticated data mining programs and software, to gain a thorough understanding of problems/issues.

Preferred:

• Certified Professional Coder - Hospital (CPC-H) and/or Certified Medical Audit Specialist (CMAS).
• Use of software tracking mechanisms for compliance issues.
• Understanding of the revenue cycle and clinical trial/research billing processes.
• Extensive knowledge of compliance program requirements, principles, and guidelines.

The annual base salary range for this position is from $95,493.00 to $143,208.00, and pay offered will be based on experience and qualifications. Although Fred Hutch is not sponsoring most H-1B visas at this time, candidates who already hold an H-1B sponsored by another organization and are currently in the U.S. may be eligible for this position.Fred Hutchinson Cancer Center offers employees a comprehensive benefits package designed to enhance health, well-being, and financial security. Benefits include medical/vision, dental, flexible spending accounts, life, disability, retirement, family life support, employee assistance program, onsite health clinic, tuition reimbursement, paid vacation (12-22 days per year), paid sick leave (12-25 days per year), paid holidays (13 days per year), paid parental leave (up to 4 weeks).