Healthcare Compliance Specialist - Organizational Integrity

Job Description

Description

PeaceHealth is seeking a Healthcare Compliance Specialist - Organizational Integrity for a 1.0 full time equivalent Exempt position. This position will be working Day shift with shift durations of 8 Hours.

JOB SUMMARY
Assists in developing and maintaining the Healthcare Compliance Program for PeaceHealth in accordance with the Department of Health and Human Services (DHHS) Office of Inspector General’s (OIG’s) Voluntary Guidelines for Hospital Compliance in 1998, the Supplemental Hospital Guidelines in 2005, Third-Party Medical Billing Companies in 1998, and other federal and state regulations. Works to prevent, detect and correct compliance risks through the development and distribution of written policies and procedures and effective compliance training. Develops and maintains effective lines of communication; responds to detected offenses, develops corrective action plans related to non-compliance. 

ESSENTIAL FUNCTIONS
1. Assists in the development, implementation, and maintenance of the Healthcare Compliance Program for PeaceHealth. Develops and writes policies and procedures that establish standards for compliance, giving specific guidance to management, operational leadership, and departments.
2. Performs audits to determine compliance with federal, state and healthcare billing requirements. Evaluates the adequacy and effectiveness of internal and operational controls. Communicates audit results to hospital service departments, departmental leadership, and other appropriate staff, and provide education. Makes recommendations for management corrective action and follows up on their timely completion.
3. Identifies and works with operational staff to determine healthcare compliance metrics. Works with other healthcare compliance staff to help develop ongoing monitoring plan.
4. Evaluates the adequacy, compliance and accuracy of documentation in support of services billed. 
5. Acts as a resource to clinical areas on compliance, documentation and coding issues. Researches laws, rules and regulations, obtains legal advice as appropriate; Assists with implementation of action plans and process improvements.
6. Assists newly-credentialed/privileged physician and non-physician providers with assessing clinical activities and determining billable services. Reviews clinical services performed by providers to assure compliance. Seeks legal advice as necessary. Educates providers concerning laws and regulations and applicability to PeaceHealth.
7. Participates in the Healthcare Compliance Program planning, including risk assessments and audit planning with annual and quarterly time lines.
8. Responds to external audits and government investigations.

9. Represent the department on committees and task forces and in various meetings. May lead compliance projects, conduct investigations, and chair task forces/committees.
10. Performs other duties as assigned.

QUALIFICATIONS

EDUCATION: Bachelor’s degree or equivalent knowledge and skills obtained through a combination of education, training and experience.

EXPERIENCE/TRAINING:

·Minimum of five years compliance experience (within compliance or clinical departments) and/or coding in a healthcare setting required.

·Medical records management experience preferred.

·Clinical experience preferred.

LICENSE/CERTIFICATION: Certified Healthcare Compliance (CHC) required. Must obtain certification within 18 months from hire date if not obtained at time of hire.

OTHER SKILLS:

·Strong interpersonal skills and evidence of previous success in dealing with staff at all levels, including nurses, non-physician practitioners, physicians, and management. 

·Strong presentation skills and ability to interact with all levels of leadership across the PeaceHealth continuum. 

·Knowledge of Medicare and Medicaid documentation and coding rules and guidelines.

·Knowledge of healthcare compliance audit methodologies, principles and techniques.

·Ability to interpret and apply documentation and coding rules and regulations, facility fee charge capture and reimbursement methodologies.

·Clear, intentional and strategic communicator.

·Demonstrated proactiveness and ability to work independently and self-directed in managing multiple concurrent projects.

·Excellent analytical and problem solving skills.

·Advanced skills in all MS Office applications (Word, Excel, Outlook, PowerPoint). 

REGIONAL/LOCATION SPECIFIC NOTES: May need to travel to off-site PeaceHealth locations as necessary.

Physical/Cognitive Requirements: 

• Work requires fairly light physical exertion from up to 65% of the time.
•  Ability to lift objects weighing 30 lbs. or less.
• Work is performed under normal working conditions with adequate lighting and ventilation.
• Job duties frequently require intense concentration and attention to detail (up to 65% of work time).

About Us

PeaceHealth, based in Vancouver, WA, is a not-for-profit Catholic health system employing approximately 16,000 caregivers, a multi-specialty medical group practice with more than 1,200 providers and 10 medical centers serving both urban and rural communities in Washington, Oregon, Alaska. In 1890, the Sisters of St. Joseph of Peace founded what has become PeaceHealth. Today, the legacy of its founding Sisters continues with a spirit of respect, stewardship, collaboration and social justice in fulfilling its Mission. 

Get a feeling for the Spirit of PeaceHealth through this three-minute video, and visit us on Facebook or LinkedIn! We offer competitive compensation, a robust benefitspackage and a collaborative, Mission-driven work environment!

To learn more please visit: jobs.peacehealth.org. Questions? Review our Employment FAQor email [email protected]. Please note this email does not accept resumes or applications.

See how PeaceHealth is committed to Diversity & Inclusion

For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state, or federal laws.