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Healthcare Compliance Analyst Job Family - Levels I - III Full Time - Ethics and Compliance Department - Position Closes: 1/20/2022

Alaska Native Tribal Health Consortium

Healthcare Compliance Analyst Job Family - Levels I - III Full Time - Ethics and Compliance Department - Position Closes: 1/20/2022

Anchorage, AK
Full Time
Paid
  • Responsibilities

    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

    • Analyzes and audits revenue cycle work processes, internal controls, policies, and procedures for organizational, regulatory, and third party payer compliance. Schedules, plans, drafts scopes of work, and coordinate resources for internal compliance audits and external contract compliance audits. Coordinates and performs compliance analysis and auditing activities for the hospital and specialty clinics in accordance with generally accepted auditing practices. Utilizes approved standard model format to analyze and record sufficient, reliable information to identify audit objectives and scope upfront, and ensure appropriate analyses and evaluation of findings to support conclusions.
    • Prepares written findings, recommendations, and corrective action plans. Shares relevant information with Compliance & Privacy Officer and operational stakeholders. Refers issues that may involve non-compliance, misconduct, voluntary disclosures, and/or refunds to the Compliance & Privacy Officer. Monitors corrective action plans for management accountability. Track and trend compliance analysis and auditing activities in compliance database system. Prepares oral and written compliance analysis and audit reports.
    • Collaborates with organizational stakeholders to identify and evaluate opportunities to mitigate risks and trends for compliance of revenue cycle activities with industry standards and regulatory/payer guidance on issues such as medical necessity, accurate and complete health record documentation, coding, data and charge entry, billing and claims management.

    HEALTHCARE COMPLIANCE ANALYST III

    • Assists in the implementation of compliance initiatives, serving as a resource and providing guidance on privacy and compliance related matters, including uses and disclosures of protected health information.
    • Possesses knowledge of and proficiency in interpreting local, State and Federal compliance and privacy laws and regulations and collaborates with internal/external auditors, business partners, committees, consultants, federal/state agency staff, contractors, and fiscal intermediaries.
    • Research, analyze, and interpret laws, regulations, and contracts; develop, review, and update policies and procedures; conduct routine or focused reviews for adherence to Federal, State, and local regulatory and contractual requirements, as well as organizational needs;
    • Drafts compliance analysis and audit departmental policies, procedures, and annual audit plans. Provides sound advice, consultation, and feedback on revenue cycle compliance issues. Participates in revenue cycle committees. Monitors and reviews trends in compliance analysis and audit programs. Makes recommendations for continuous program improvements consistent with HHS Office of Inspector General Compliance Guidance, U.S. Sentencing Commission, False Claims Act, State of Alaska, Joint Commission, and others applicable regulatory and accreditation agencies.
    • Mentors and trains entry level Healthcare Compliance Analyst I.

     

    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

    • Bachelor’s Degree in Political Science, Economics, Public Affairs, Political Communications, Health Information Management, Health Care Administration, Public Policy, Public Administration, Business, Rural Development, or Social Services. Progressively responsible professional work-related experience, education, or training may be substituted on a year-for-year basis for college education.

     

    MINIMUM EXPERIENCE QUALIFICATION

    • Healthcare Compliance Analyst I
    • Non-supervisory - One (1) year of work experience in a healthcare compliance, revenue cycle or coding setting. An equivalent combination of relevant education and/or training may be substituted for experience.

     

    HEALTHCARE COMPLIANCE ANALYST II

    • Non-supervisory – Five (5) years of work experience reviewing, analyzing, and summarizing data in Excel and PowerPoint required. Experience reading, comprehending and implementing state and federal regulations, payer program memorandum, and other complex, technical and/or legal documents.

     

    HEALTHCARE COMPLIANCE ANALYST III

    • Non-supervisory – Ten (10) years of work experience reviewing, analyzing, and summarizing data in Excel and PowerPoint required. Experience reading, comprehending and implementing state and federal regulations, payer program memorandum, and other complex, technical and/or legal documents.

    TO INCLUDE

    • Supervisory - Three (3) years involving employee supervision.

     

    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

    • Master’s Degree in Health Information Management or Healthcare Compliance

     

    PREFERRED EXPERIENCE QUALIFICATION N/A

    PREFERRED CERTIFICATION QUALIFICATION

    • Certified in Healthcare Compliance or Certified in Healthcare Privacy (CHC or CHPC)
    • Certified in Healthcare Privacy and Security (CHPS)
    • Certified Clinical Documentation Specialist (CCDS)
    • Certified Professional Medical Auditor (CPMA)

     

    ADDITIONAL REQUIREMENTS:

    HEALTHCARE COMPLIANCE ANALYST II

    • Working knowledge of hospital coding and billing principles and practices required, including knowledge of ICD-10-PCS, ICD-10-CM; and CPT diagnostic and procedure codes, and Medicare prospective payment systems (including inpatient, outpatient, and home health)

     

    HEALTHCARE COMPLIANCE ANALYST III

    • Experience reading, comprehending and implementing state and federal regulations, payer program memorandum, and other complex, technical and/or legal documents

     

    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.

  • Qualifications

    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

  • Industry
    Hospital and Health Care