Compliance Consultant

The Compliance Consultant works under the supervision of the Director of Compliance. This position plans, administers, maintains and coordinates compliance processes, policies and procedures as well as applicable laws and regulations for the organization. The Consultant documents regulatory research and guidance, compliance projects, designs and executes risk assessments, develops audits and monitoring techniques to test adherence to policies, procedures, and compliance standards, designs and executes training and education, assists leadership in process improvement to ensure compliance with laws and regulation. Coordinates efforts with Managers of Internal Audit, Information Security and Enrollment.

• Reviews a wide variety of organization policies and procedures to ensure compliance with legal, accreditation, and internal standards. Analyzes existing policies, identify gaps and recommend new/revised standards, approval processes, and monitoring methods for departmental use. Review detailed departmental processes and policies noting deficiencies.
• Researches and develops materials for educational programs related to all aspects of compliance, including federal guidelines, and responses to investigations.
• Designs and executes risk assessments to analyze the effectiveness of the Compliance Program, identifying areas for improvement. Develop monitoring plan to determine if the action plan is being adhered. Prioritize issues of risk assessments based on level of the organization exposure. Receive quarterly reports on status of risk monitoring and analyze reported results identifying trends and developing corrective action where appropriate.
• Manages the process of investigation and response to issues identified by the Recovery Audit Contractor (RAC), Medicare Administrative Contractor MAC, Zone Program Integrity Contractor (Z-PIC) or Medicaid Integrity Contractor (MIC). Collaborates with Health Information Services, Patient Financial Services, and/or Care Management to monitor and track results and need for Performance Improvement Action Plans. Audits potential issues before they are identified by the regulatory auditors.
• Investigates allegations and facilitates the remediation gaps and escalates possible critical issues to management, administration, and leadership through to resolution, if necessary. Prepares written narrative of findings, assigns and assesses action plans, and follows up to ensure compliance to agree to actions.
• Designs and executes compliance audits throughout the organization. Verify compliance/noncompliance issues against established policies and procedures and applicable laws and regulations. Facilitates the remediation of noncompliance and escalates possible critical issues to administration, leadership, and management through the resolution, if needed. Audits may focus on but are not limited to documentation, billing, coding, medical necessity, and reimbursement. Develop recommendations for corrective action based on review findings and works with service/process administrator and department management to refine recommendations. Develop presentation for leadership on results of assessment.
• Performs quality/process improvements. Develop, recommend and assist with process creation process and structure standards regarding compliance. Establish guidelines and procedures to enhance customer service; plan and conduct meetings to ensure compliance with established procedures, assist leaders in compliance process design, and assist to implement new policies.
• Evaluates new and existing legislation and regulatory guidelines and disseminate education to impacted caregivers and leadership to ensure future compliance. If necessary, assist leadership with development of regulations, materials and resources used to educate caregivers on compliance program objectives.
• Perform a variety of administrative duties with latitude for exercising discretion and judgment. Receive and answer correspondence. Arrange and schedule appointments, including interviewing callers, and making proper referrals; and supervise the preparation of materials for meetings.
• Receive confidential questions/concerns from caregivers concerning compliance situations. Investigate questions/concerns received by e-mail, voice-mail, ""hotline,"" drop-ins, etc., to determine specifics and provide recommendations for resolution or refers concern to appropriate individual(s) for follow-up. Rounds on customers to determine their needs.
• Other duties as assigned

• Bachelor's Degree - Accredited college or university or an equivalent combination of education and/or experience - Required

• Proficiency in Microsoft Word, Excel, Access and Power Point - Required
• 5 Years - Coding/billing experience in health care industry, with specific experience typically obtained as a coder, consultant, and/or auditor - Preferred
• Prior experience performing physician coding audits or experience working with physicians to correct coding and documentation issues with demonstrated success - Preferred

• Certified Professional Coder (CPC) - Preferred within 1 Year Or
• Certified Coding Specialist-Physician-based (CCS-P) - Preferred within 1 Year Or
• Registered Health Information Technician (RHIT) - Preferred within 1 Year Or
• Registered Health Information Administrator (RHIA) - Preferred within 1 Year

• Travel to off-site locations may be required. - Required

Essential Technical/Motor Skills

• Input data, type, manipulate calculator and small business equipment, speak clearly and professionally, answer telephone, copying.

Interpersonal Skills

• Demonstrated ability and self-confidence to work independently with minimal supervision.
• Ability and desire to work with administrators, leadership, providers, and caregivers to achieve consensus, resolve inquiries, complaints and concerns.
• Ability to maintain objectivity and independence when working with caregivers, leadership, and providers.
• Advanced research skills including ability to locate, interpret, and provide guidance of regulations, laws, legal documents, coding and billing guidelines, and contracts.
• Must demonstrate Analytical, organizational, problem solving, decision making, listening, negotiating, mentoring, and influencing skills.
• Ability to plan and execute multiple projects simultaneously.
• Demonstrated and effective inter- and intrapersonal people skills.
• Good project management skills to implement compliance and privacy initiatives, including project planning, scheduling, oversight, and implementation in accordance with project target completion dates.
• Ability to communicate via written or small and large group presentations.
• Must possess excellent oral and written communications skills and present a positive image for the organization.
• Must be motivated, able to work independently, be a strong facilitator and have excellent follow through skills.
• Must be able to interact with people in a professional, diplomatic, and sensitive manner and ensure that appropriate confidentiality is maintained.
• Communicate effectively, both verbally and in writing, with all levels of staff and leadership, the public, and agency representatives.

Essential Physical Requirements

• Lifting, moving, reaching, bending, stooping, standing, walking, reading, typing, operating small business equipment.

Essential Mental Abilities

• Independent thinking and in-depth analysis skills.
• Ability to Analyze, synthesizes, evaluate, comprehend, explain, understand, forecast, interpret, and manipulate data.

Essential Sensory Requirements

Exposure to Hazards

Other Skills and Abilities