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Position Summary: The Senior Compliance Analyst is responsible for performing audits to help ensure compliance with applicable statutory and regulatory requirements. Operational responsibilities include, but are not limited to, assisting in developing, and completing activities related to the annual auditing and monitoring calendar. Works independently and collaborates with others across the health system to ensure compliant processes that meet the requirements of regulatory agencies and Tidelands Health policies and procedures. This position will conduct training, investigations, and audits.

Responsibilities include:

• Reviews and analyzes patient accounts and medical records for accuracy of documentation, medical coding, charge capture, and compliance with Medicare, Medicaid, TRICARE, and other applicable statutory and regulatory requirements

• Assists in investigation of all requested audits to include analyzing, researching, monitoring and reporting results as appropriate

• Perform proactive and reactive audits

• Assists in training Tidelands Health workforce on compliance related topics

• Investigates HIPAA Privacy & Security events

• Identifies potential areas for audits based on the OIG and PGBA probe and educate information

• Assists and participates in Compliance Council and Board Audit Compliance Committee at request of Chief Compliance Officer

• Reports all compliance, HIPAA, and risk issues to Compliance Officer

• Attend seminars and in-services as required to remain current on compliance issues, including coding and documentation

QUALIFICATIONS

Experience:

• Minimum of five years of experience in facility and professional auditing required

• In depth knowledge of E/M coding or auditing to include inpatient and outpatient services, as well as specialty office coding to include medical terminology, CPT, ICD-10-CM, ICD-10-PCS, HCPCS

• In depth understanding of compliant billing related to government programs (Medicare, Medicaid & Tricare)

• Working knowledge of health care related legislation and standards for correct charge capture and documentation

• Hands on experience with eClinical Works and Meditech or other hospital billing software applications preferred

• Knowledge of CMS, OCR, OIG, and OSHA regulations for in and outpatient facilities

Education:

• Bachelor’s Degree from an accredited college or university with a concentration in Health Information Management, Business Administration, Healthcare Administration, or a clinic related field preferred

• Certification in healthcare compliance preferred

• Coding and/or auditing certification required

Knowledge/Skills/Abilities:

• Maintain up-to-date Knowledge of federal laws and regulations affecting coding requirements

• Working knowledge of official coding conventions and rules established by the AMA, CMS, PGBA LCDs & NCDs

• Ability to collaborate with administration, physicians, auditors, clinical and financial departments to ensure effective and efficient processes for optimal revenue cycle outcomes and constituents at all levels of the organization required

• Uses knowledge of healthcare payer requirements for revenue capture and revenue cycle financial indicator performance improvement

• Ability to work independently and without immediate supervision

• Knowledge of healthcare revenue cycle processes (financial and operational preferred)

• Excellent written and verbal communication skills

• Exemplary presentation and facilitation skills and the ability to lead group discussions preferred

• LEAN, Six Sigma training preferred

• Demonstrated analysis and problem-solving skills required

• Proficiency in computer software applications such as Microsoft Access, Project, Excel, Power Point, Word, and other Office applications required

• Team player and have a thorough knowledge of the team concept required

• High degree of initiative and ability to utilize good time management, available resources and performance measurements required

Ability to work well with ambiguity and continuous change required

• Primarily M–F day shift hours, but Manager Compliance will alter schedule to meet the needs of the organization (ie: Nights, weekends and holidays as needed)

• Frequent interruptions and requirement to performing several job functions simultaneously, and often at varying locations throughout the GHS system

Physical Requirements: Light/Medium Physical Agility Test (PAT) Rating

While performing the duties of this job, the employee is frequently (activity or condition exists from 1/3 to 2/3 of the time) required to stand, sit, and walk; frequently to use hands, fingers; and frequently to talk or hear. The employee must exert 15 to 20 pounds of force occasionally (activity or condition exists up to 1/3 of the time), and/or 5 to 10 pounds of force frequently, and/or greater than negligible up to 5 pounds of force constantly to move objects.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Job ID: 2021-8607

Shift: Weekday - Days

External Company URL: http://www.tidelandshealth.org/

Street: 606 Black River Road