Healthcare Compliance & Internal Audit Sr. Consultant

Change Healthcare   •  

NJ

Industry: Healthcare

  •  

5 - 7 years

Posted 57 days ago

This job is no longer available.

Transforming the future of healthcare isn’t something we take lightly. It takes teams of the best and the brightest, working together to make an impact.

As one of the largest healthcare technology companies in the U.S., we are a catalyst to accelerate the journey toward improved lives and healthier communities.

Here at Change Healthcare, we’re using our influence to drive positive changes across the industry, and we want motivated and passionate people like you to help us continue to bring new and innovative ideas to life.

If you’re ready to embrace your passion and do what you love with a company that’s committed to supporting your future, then you belong at Change Healthcare.

Pursue purpose. Champion innovation. Earn trust. Be agile. Include all.

Empower Your Future. Make a Difference.

The Compliance & Internal Audit Senior Consultant is a member of the Advisory Services Division and reports to the Compliance & Internal Audit Director. This position will provide healthcare regulatory compliance support within provider and payor clients and ensure the organization is working and operating in accordance with the most up to date applicable laws and regulations pertaining to federal and state regulatory requirements, including but not limited to regulations and guidance set by the Department of Health and Human Services (HHS) through the Centers for Medicare and Medicaid Services (CMS), the Office of Inspector General (OIG), and the Office of Civil Rights (OCR) and applicable state mandated guidelines. The below responsibilities will be carried out and managed under the guidance and supervision of the Director.

Location: Remote/Telecommuter position. Must live close to a major metro airport and be willing to do some overnight travel.

KEY RESPONSIBILITIES

  • May provide project oversight and leadership to other team members.
  • Research and track applicable state and federal laws and agency regulations as they relate to client engagements.
  • Stay apprised of new regulatory developments and guidance by reviewing regulatory publications, applicable industry trade publications, legal requirements, pending legislation and past/current lawsuits and litigation as it relates to client projects.
  • Analyze the impact of applicable regulations and guidance on client organizations and create and implement audit and remediation plans.
  • Formulate and drive strategies to ensure client compliance with regulatory authorities and agencies.
  • Manage regulatory affairs projects and implement necessary programs, policies, procedures, or processes as they relate to regulatory compliance within the organization.
  • Update documentation, and provide education materials and general/targeted training relating to regulatory and guidance updates.
  • Attend calls, meetings, and other education sessions, as well as participate in workgroups to stay the most up to date on regulatory requirements.
  • Maintain expertise in assigned research topic(s) to support identified client regulatory compliance needs, and monitor and advise on practices and documentation related to regulatory compliance.
  • Actively participate in the development of client risk assessment plans, ongoing monitoring, policy and procedure development and processes as they relate to regulatory requirements and guidance.
  • May provide interim staffing for Compliance, Internal Audit and/or Enterprise Risk Management.
  • Assist with other compliance and auditing tasks as needed.

MINIMUM JOB Qualifications

Five (5) years’ experience in a role related to services of the division.

Education / Training:

  • Bachelor’s Degree or 4 years equivalent on the job experience with progressing responsibility.
  • Prefer active coding/billing related certification (i.e. RHIA or RHIT or CCS, CCA, COC (formerly CPC-H), CCS-P, CPC)
  • Require atleast one certification from the following list:
    • Accredited Healthcare Fraud Investigation (AHFI)
    • Certified Fraud Examiner (CFE)
    • Coding Specialist (CCS)
    • Coding Specialist - PhysicianBased (CCS-P)
    • Controls Self-Assessment (CCSA)
    • Financial Forensics (CFF)
    • Healthcare Compliance (CHC)
    • Healthcare Privacy Compliance (CHPC)
    • InternalAudit (CIA)
    • Internal Controls Auditor (CICA)
    • Information Systems Auditor (CISA)
    • Network Engineer (CNE)
    • Paralegal (CP)
    • Professional Coder (CPC)
    • Public Accountant (CPA)
    • Chartered Global Management Accountant (CGMA)
    • Master of Business Administration (MBA)
    • Microsoft Certified Professional (MCP)
    • Registered Health Information Technician (RHIT)
    • Registered Nurse (RN)

CRITICAL SKILLS:

  • Advanced knowledge of ICD-9-CM, ICD-10-CM, Official Coding Guidelines.
  • In-depth understanding of laws, rules and regulations related:
    • Healthcare Compliance, Ethics and HIPAA;
    • Healthcare provider claim preparation, submission and billing (facility and professional fees);
    • Federal health care programs and reimbursement cycle; and
    • Services by acute and non-acute care hospitals
  • Intermediate to complex knowledge of medical terminology, pharmacology and anatomy and physiology.
  • Familiar with medical records content, format and other pertinent procedures.
  • Proficient & competent computer skills including Microsoft Word, Excel and e-mail.
  • Strong critical thinking skills.
  • Excellent written and oral communication skills.

WORKING CONDITIONS:

  • Remote position.
  • Willingness to work some weekends and evening hours to meet changing client goals.
  • Participate in testing and training as required by the Company.
  • May need to attend Healthcare conferences as needed.
  • Travel nationwide as required and carry laptop computer on travel assignments.

Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!

Equal Opportunity/Affirmative Action Commitment

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

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