[Hiring] Senior Compliance Specialist @CommonSpirit Health

Role Description

As our Senior Compliance Specialist, you will support the CommonSpirit Health Corporate Responsibility Program by developing, implementing, and maintaining an effective and comprehensive compliance auditing and monitoring program.

• Conduct and facilitate compliance audits for acute and non-acute care services.
• Analyze outcomes and communicate findings.
• Contribute to ongoing auditing and monitoring efforts across CommonSpirit Health to ensure regulatory adherence.
• Support CRP leadership in developing, implementing, and maintaining the compliance monitoring/auditing work plan.
• Focus primary reviews/audits on coding and medical necessity documentation guidelines.
• Determine monitoring/auditing procedures, including the use of computer-assisted audit techniques.
• Utilize data analytics to develop and assess coding and clinical outlier risks in conjunction with clinical services and other functional groups.
• Monitor government recovery audit efforts for trends and patterns of non-compliance with billing, medical necessity, and coding issues affecting acute and non-acute care services.
• Work closely with Health Information Management (HIM), revenue cycle, legal services group, advocacy, and other applicable functional areas to ensure proper interpretation, dissemination, and ongoing internal auditing and monitoring of compliance with laws and regulations related to coding compliance and medical necessity.
• Support leadership in the development, implementation, maintenance, and evaluation of policies, procedures, tools, and templates to address changes in current laws and regulations related to coding compliance and medical necessity.
• Develop education designed to promote understanding of coding compliance and medical necessity issues, laws and regulations, and consequences of noncompliance.
• Analyze reports, data, and trends to keep management and governance informed of the current regulatory environment impacting coding and medical necessity compliance and the potential impact to CommonSpirit Health.

Qualifications

• Bachelors Of Science Nursing or equivalent experience may be considered in lieu of degree.
• 5 years progressive experience in healthcare operations including clinical, regulatory compliance, risk management, audit, law, or related field.
• Certified Health Care Compliance (CHC).
• Registered Health Information Technician (RHIT).
• Registered Health Information Administrator (RHIA).
• Certified Coding Specialist - Physician Based (CCS-P).
• Certified Coding Specialist (CCS).

Company Description