Compliance Analyst | Full Time | Days

Summary

This position is a part of the Compliance Department and reports to the Director of Compliance and Internal Audit.   Work with designated operational departments to implement Medicare and Medicaid regulations and ensure continued compliance while optimizing business processes.  The Compliance Analyst will conduct inpatient and outpatient coding, billing, and medical record documentation reviews in accordance with Federal, state and local regulations.  The position will be responsible for responding to selected government payer audits.   The Compliance Analyst will stay up to date with current transmittals, listservs, and regulatory notices for department distribution, education and reporting activities. Other duties as assigned.

Education

Four years of formal training or education in specialty or related field beyond the high school level, or equivalent experience. Bachelors Degree preferred.

Experience

Previous experience healthcare billing or coding preferred.  Demonstrated ability to work collaboratively with individuals at all levels of an organization.

Demonstrated working knowledge of Medicare regulations and provisions and a demonstrated aptitude to effectively assist and educate all stakeholders in the application of Medicare requirements to all aspects of patient billing. Have a working knowledge of the Office of Inspector General (OIG) Compliance Program Guidance for Hospitals and OIG Supplemental Compliance Program Guidance for Hospitals, Annual OIG Work Plans, Medicare Outpatient Prospective System, Ambulatory Payment System, Diagnosis Related Grouping, Medicare Inpatient Prospective System, Local Coverage Determinations and National Coverage Determinations. Knowledge of the Medicare Manual Systems, i.e. Internet and paper manuals, transmittals. The ability to navigate the Medicare online resource sites, Code of Federal Regulations, Conditions of Participation, Federal Register, etc.

Should be proficient with Microsoft Office applications such as Word, Excel, and PowerPoint.

Responsibilities

• Working with other members of the Compliance Department, evaluates the annual Work Plan published by the Office of Inspector General (OIG) in order to evaluate the hospital’s compliance with known OIG enforcement priorities.  Participates in the hospital’s annual risk assessment and development of the hospital’s Compliance Work plan.

• Works with the Compliance team in responding to selected government payer audits.  Specifically, assists in creating documentation checklists and gathering documentation for selected audits.  Identifies methods for streamlining the hospital’s response to document requests.  Assists with tasks involved in performing routine monitoring and auditing of documentation as it relates to medical necessity and compliance with local coverage determinations (LCD) and national coverage determinations (NCD).  Responsible for conducting audits of medical records to determine whether services provided to patient are appropriately documented and billed in accordance with Medicare, Medicaid regulations and/or standards.

• Maintains a working knowledge of relevant compliance issues, laws, and regulations through list serves, professional organizations, seminars, training programs and online regulatory compliance guidance.  Disseminates summaries to appropriate hospital employees.

• Serves as a resource for employee questions, complaints, issues or concerns about compliance. 

• At the direction of the Director of Compliance and Internal Audit, works to establish, implement, and oversee standard policies, procedures, processes, and best practices to promote compliance with applicable laws, regulations, and contractual obligations.

• Participates in and supports departmental and organizational change.

• Assists and provides direction for compliance audit or inspection activities from federal, state and local government agencies related to compliance activities.  Serves as a resource to the hospital for audits and information gathering for external healthcare exchanges.

• Assists hospital staff in the implementation of necessary procedures to correct any compliance deficiencies discovered and makes recommendations to incorporate changes to reduce or mitigate risk.

• Contributes to the compliance culture throughout the health system including by advertising the compliance program and the reporting process.

Concord Hospital is an Equal Employment Opportunity employer. It is our policy to provide equal opportunity to all employees and applicants and to prohibit any discrimination because of race, color, religion, sex, sexual orientation, gender, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status.

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If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, you may contact Human Resources at 603-230-7269.

Physical and Work Environment Requirements

The physical demands and characteristics of the work environment described here are representative of those that will be encountered by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The Dictionary of Occupational Titles Material Handling Classification is SEDENTARY. The employee must regularly lift, carry or push/pull less than 10 pounds, frequently lift, carry or push/pull less than 10 pounds, and occasionally lift, carry or push/pull up to 10 pounds.

While performing the duties of this Job, the employee is regularly required to hear. The employee is frequently required to reach, sit, speak, and walk. The employee is occasionally required to climb, perform activities that require fine motor skills, and stand.

Specific vision abilities required by this job include far vision and near vision.

The noise level in the work environment is usually quiet.