PRIMARY JOB FUNCTION(S):

• Independently performs scheduled audits required by the work plan and unplanned investigations
• Provides compliance guidance to personnel
• Answers questions and provides guidance on coding and/or billing issues
• Works with team to determine appropriate corrective action when necessary
• Monitors and respond to certain regulatory request
• Represents the Compliance Department on various committees as requested
• Generates narrative and quantitative reports concerning all activities.
• Prepares information required for designated meetings.

• Contributes to a work atmosphere in a manner which is positive, enthusiastic, respectful and courteous.
• Ability to follow detailed instructions.

• Uses technology for the completion of specified job duties and assists staff in learning to use the technology.

• Attends work regularly according to assigned work schedule and in accordance with Agency policy.
• Attends and participates in in-service training, staff meetings and other activities to facilitate professional development.

• Works cooperatively with others including staff, supervisors, administrators, co-workers, individuals served, community professionals, customers, vendors and the public.
• Assist with plans of correction for OHCQ site visit reports within applicable time frame(s) and ensures completion of corrective actions.
• Provides scheduled staff training as determined by the training department.
• Works a flexible schedule consisting of evening hours as needed.
• Assumes other administrative duties, responsibilities and special projects as assigned

REQUIREMENTS:

Obtain CI certification within 90 days of hire

Driver’s license

EDUCATION:

BA Degree preferred

EXPERIENCE:

• Professional level of knowledge of billing practices and procedures
• In depth knowledge in the areas of Medicare and Medicaid, and commercial insurance billing regulations
• Minimum of 5 years’ experience in a healthcare compliance program, however provider payment and healthcare coding experience may be used toward experience requirement
• Familiarity with the healthcare regulatory environment
• Knowledge of basic coding and healthcare licensing/accreditation standards is required
• Knowledge of multi state and federal laws and regulation with affect compliance operations

Experience

• 5 year(s): Minimum of 5 years experience in a healthcare compliance program

Education

• Bachelors or better

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)