Job Description

Overview:

FTE: 1.0


Mon-Fri - 8:00 am to 5:00 pm



To provide ongoing compliance monitoring and auditing functions for a multi-hospital healthcare system, including reviews of regulatory requirements, audits, billing, coding, documentation, medical necessity, and other general compliance processes and analyses that support appropriate reimbursement and adherence to applicable laws, rules, guidelines, and regulations. This role also provides ongoing compliance education and training, researches and responds to compliance inquiries, follows investigation protocols, and addresses reported, suspected, or confirmed non-compliance. Additionally, it participates in compliance meetings that foster open communication across the organization, assists with the development and monitoring of special compliance projects in partnership with Compliance Managers and hospital departments, and provides compliance advice and guidance as needed.


Qualifications:

Minimum Education & Experience

Bachelor's degree

and

2 years of compliance, clinical, coding, auditing, legal, or related experience;

OR

Associate's degree in a health- or business-related field

and

4 years of compliance, clinical, coding, auditing, legal, or related experience;

OR

Certifications in Compliance, Coding, and/or Auditing

and

6 years of compliance, clinical, coding, auditing, legal, or related experience, plus knowledge of healthcare laws and regulations.

Licensure & Certifications

CHC (Certified in Healthcare Compliance) required

+ May be obtained within 12 months of hire or transfer.
Preferred: RN, LPN, RHIA, RHIT, CPC-H/COC, CPC, or CCS.

Knowledge, Skills & Abilities

Familiarity with hospital billing systems and medical records. Strong coding skills and a clinical background preferred. Knowledge of Medicare, Medicaid, and state/federal healthcare regulations. Ability to research and interpret complex regulations. Strong problem-solving skills. Proficiency with MS Office (Excel, Word, PowerPoint). Must be organized, versatile, and able to work independently.

Motor Vehicle Operator Designation

* Position requires operating vehicles for business purposes as a

non-frequent driver

.