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PeaceHealth Healthcare Compliance Specialist - Organizational Integrity in Vancouver, Washington

Description

PeaceHealth is seeking a Healthcare Compliance Specialist - Organizational Integrity for a Full Time, 1.00 FTE, Day position.

Must be fully vaccinated for COVID-19 including 2 doses of a 2-dose series or 1 dose of a 1-dose series plus 14 days beyond the final dose prior to start date.

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

  • 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.

  • 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.

  • Identifies and works with operational staff to determine healthcare compliance metrics. Works with other healthcare compliance staff to help develop ongoing monitoring plan.

  • Evaluates the adequacy, compliance and accuracy of documentation in support of services billed.

  • 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.

  • 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.

  • Participates in the Healthcare Compliance Program planning, including risk assessments and audit planning with annual and quarterly time lines.

  • Responds to external audits and government investigations.

  • Represent the department on committees and task forces and in various meetings. May lead compliance projects, conduct investigations, and chair task forces/committees.

  • 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).

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. Reasonably anticipated exposure to blood and body fluids.

  • Job duties frequently require intense concentration and attention to detail (up to 65% of work time).

See how PeaceHealth is committed to Inclusivity, Respect for Diversity and Cultural Humility (https://www.thecaregiver.org/wp-content/uploads/2017/05/PeaceHealth-Statement-of-Commitment-to-Diversity-and-Inclusion-vFINAL.pdf) .

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.

REQNUMBER: 17432

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