Healthcare Compliance Analyst Job Family - Levels I - III Full Time - Ethics and Compliance Department - Position Closes: 1/20/2022
JOB SUMMARY: Under general supervision, designs and executes the annual compliance audit plan consistent with the annual compliance plan, placing particular emphasis on the revenue cycle and other high risk financial and operational risk areas to identify existing and potential compliance issues and to directly support compliance with applicable ethical standards, laws, regulations, rules, policies, procedures, and professional practice standards. The following duties are intended to provide a representative summary of the major duties and responsibilities and ARE NOT intended to serve as a comprehensive list of all duties performed by all employees in this classification. Incumbent(s) may not be required to perform all duties listed and may be required to perform additional, position-specific duties.
REPRESENTATIVE DUTIES All As requested, generates and evaluates data from the electronic medical record system to support monitoring efforts to enhance compliance with documentation. Performs ongoing compliance audits to assess effectiveness of policies/procedures and compliance safeguards. Summarizes monitoring findings and provides feedback and education to clinical operations and management. Recommends corrective actions/solutions when monitoring efforts identify areas of non-compliance and follows up on recommendations to evaluate and report on status of recommended corrective actions/solutions.
Performs other duties as assigned or required.
HEALTHCARE COMPLIANCE ANALYST II
HEALTHCARE COMPLIANCE ANALYST III
Required Skills
KNOWLEDGE AND SKILLS
All • Knowledge of Alaska Tribal Health System, ANTHC, and Alaska Native culture(s). • Skill in oral and written communication. • Skill in managing multiple priorities and tasks concurrently and meeting deadlines. • Skill in establishing and maintaining cooperative working relationships with others. • Skill in operating a personal computer utilizing a variety of applications • Skill in utilizing Microsoft Excel
HEALTHCARE COMPLIANCE ANALYST II • Knowledge of compliance investigation procedures. • Knowledge of compliance analysis and auditing practices. • Knowledge of Billing and Coding. • Knowledge of applicable federal/state laws and regulations, and other operational guidelines and directives. • Knowledge of professional practice standards for health care organization revenue cycle activities. • Skill in presenting and explaining complex regulatory requirements in common language • Skill in project management, assessing, prioritizing multiple tasks, projects, and demands. • Skill in applying effective education and training techniques. • Skill in reading and interpreting financial reports and legal documents. • Skill in developing and conducting effective presentations to audiences.
HEALTHCARE COMPLIANCE ANALYST III • Knowledge of accreditation standards and auditing • Knowledge of Billing and Coding compliance • Knowledge of health care system regulation and participation rules • Skill in performing risk assessment and monitoring improvement action plans • Skill in developing mitigation strategies to reduce risk • Skill in writing policies and procedures • Skill in critical thinking, problem-solving and ethical decision-making
Required Experience
MINIMUM EDUCATION QUALIFICATION All A high school diploma or GED equivalent.
HEALTHCARE COMPLIANCE ANALYST II AND III
MINIMUM EXPERIENCE QUALIFICATION
HEALTHCARE COMPLIANCE ANALYST II
HEALTHCARE COMPLIANCE ANALYST III
TO INCLUDE
MINIMUM CERTIFICATION QUALIFICATION
HEALTHCARE COMPLIANCE ANALYST I:
• Certified Coding Associate (CCA) • Certified Coding Specialist (CCS) • Certified Coding Specialist-Physician Based (CCS-P) • Registered Health Information Technician (RHIT)
HEALTHCARE COMPLIANCE ANALYST II:
• Certified Coding Specialist (CCS) • Certified Coding Specialist-Physician Based (CCS-P) • Registered Health Information Administrator (RHIA)
HEALTHCARE COMPLIANCE ANALYST III:
• Certified Professional Coder (CPC) • Certified Coding Specialist (CCS) • Certified Coding Specialist-Physician Based (CCS-P) • Registered Health Information Administrator (RHIA)
PREFERRED EDUCATION QUALIFICATION
PREFERRED EXPERIENCE QUALIFICATION N/A
PREFERRED CERTIFICATION QUALIFICATION
ADDITIONAL REQUIREMENTS:
HEALTHCARE COMPLIANCE ANALYST II
HEALTHCARE COMPLIANCE ANALYST III
WORKING CONDITIONS
The following demands are representative of those that must be met by an employee to successfully perform the essential functions of this job: • This position requires persistent repetitive movements of the hands, wrists and fingers and the ability to sit for long periods. • Must be able to lift approximately 20 pounds.
KNOWLEDGE AND SKILLS
All • Knowledge of Alaska Tribal Health System, ANTHC, and Alaska Native culture(s). • Skill in oral and written communication. • Skill in managing multiple priorities and tasks concurrently and meeting deadlines. • Skill in establishing and maintaining cooperative working relationships with others. • Skill in operating a personal computer utilizing a variety of applications • Skill in utilizing Microsoft Excel
HEALTHCARE COMPLIANCE ANALYST II • Knowledge of compliance investigation procedures. • Knowledge of compliance analysis and auditing practices. • Knowledge of Billing and Coding. • Knowledge of applicable federal/state laws and regulations, and other operational guidelines and directives. • Knowledge of professional practice standards for health care organization revenue cycle activities. • Skill in presenting and explaining complex regulatory requirements in common language • Skill in project management, assessing, prioritizing multiple tasks, projects, and demands. • Skill in applying effective education and training techniques. • Skill in reading and interpreting financial reports and legal documents. • Skill in developing and conducting effective presentations to audiences.
HEALTHCARE COMPLIANCE ANALYST III • Knowledge of accreditation standards and auditing • Knowledge of Billing and Coding compliance • Knowledge of health care system regulation and participation rules • Skill in performing risk assessment and monitoring improvement action plans • Skill in developing mitigation strategies to reduce risk • Skill in writing policies and procedures • Skill in critical thinking, problem-solving and ethical decision-making