Job Description

Details Position: Compliance Consultant Department: Compliance Status: Full Time Shift: Day Shift Pay: $54,038.40 - $81,057.60 / year Summary: This position plans, administers, maintains and coordinates compliance processes, policies and procedures as well as applicable laws and regulations for the organization. This position 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 regulations. Coordinates efforts with Managers of Internal Audit, Information Security, and Enrollment. This position works under the supervision of the Director of Compliance and is employed by Mosaic Health Systems. Duties: Reviews a wide variety of organization policies and procedures to ensure compliance with legal, accreditation, and internal standards. Analyzes existing policies, identifies gaps, and recommends new/revised standards, approval processes, and monitoring methods for departmental use. Reviews 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. Develops monitoring plans to determine if the action plan is being adhered to. Prioritizes issues of risk assessments based on the level of organizational exposure. Receives quarterly reports on the status of risk monitoring and analyzes 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 the need for Performance Improvement Action Plans. Audits potential issues before they are identified by the regulatory auditors. Investigates allegations and facilitates the remediation of gaps, escalating possible critical issues to management, administration, and leadership through to resolution, if necessary. Prepares written narratives of findings, assigns and assesses action plans, and follows up to ensure compliance with agreed actions. Other duties as assigned. Qualifications: All required education is a minimum requirement. Higher levels of education are acceptable. Bachelor's degree from an accredited college or university or an equivalent combination of education and/or experience required. CPC and/or CCSP - Certified Professional Coder, RHIT - Registered Health Information Technician, or RHIA - Registered Health Information Administrator preferred within 1 year of hire. 5 years of coding/billing experience in the health care industry, with specific experience typically obtained as a coder, consultant, and/or auditor, and proficiency in Microsoft Word, Excel, Access, and PowerPoint required. Prior experience performing physician coding audits or experience working with physicians to correct coding and documentation issues with demonstrated success preferred. #J-18808-Ljbffr Mosaic Life Care

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