Compliance Specialist - Healthcare

Oklahoma Arthritis Center (OAC) is an Equal Employment Opportunity employer and considers all applicants without regard to race, religion, color, sex, national origin, age, disability, veteran status, or any other legally protected status.

Job Summary:
Responsible for acquiring the knowledge required to develop the overall compliance program and ensure compliance is maintained throughout Oklahoma Arthritis Center in accordance with all government mandated regulations and laws including but not limited to those required by the Center for Medicare and Medicaid Services (CMS), U.S. Department of Health & Human Services, the Occupational Safety and Health Administration (OSHA), and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and developing an audit plan to maintain compliance with those and any other required programs. Monitors compliance with federal, state and local regulatory requirements and remains informed of changes to laws and regulations that may affect the organization's policies and procedures. Communicates to appropriate Administration team members changes and updates in state, local and federal compliance requirements. Provides training and development with HR for staff on compliance issues and completes audits to ensure that compliance measures are being met throughout the clinic.

Essential Functions:

• Partner with clinic site managers to develop Compliance Plan: Compliance Plan should include company policies and procedures on all laws and regulations required by the U.S. Department of Health & Human Services,  Center for Medicare and Medicaid Services (including Quality Payment Program, Incentive Programs and Coding requirements, Occupational Safety and Health Administration (OSHA) requirements and regulations, Health Insurance Portability and Accountability Act of 1996 (HIPAA) requirements and regulations,  and all other local, federal and state laws and regulations that affect or could affect a medical practice, laboratory, and radiology.
• Communicate Compliance Program to all employees.
• Review Compliance Program on a regular basis to make updates based on the needs of the organizations or changes in the regulations and requirements.
• Create, initiate, maintain, and revise policies and procedures for the general operation of the Compliance Program and its related activities to prevent illegal, unethical, or improper conduct.
• Point of contact for safety incidences and/or adverse events. Responsible for documenting and submitting.
• Oversees day-to-day operation of the Compliance Program.
• Partner with Information Technology to report on status of Medicare Incentive Programs such as Quality Payment and Incentive Programs and additional requirement as dictated by changes to programs.
• Identify potential areas of compliance vulnerability and risk, develop and implement corrective action plans for resolution of problematic issues, and provide general guidance on how to avoid or deal with similar situations in the future.
• Conduct and coordinate internal and external compliance audits and reviews, to include OSHA audits, HIPAA audits, Provider Chart audits and Billing Chart audits, as well as other audits as needed, required or requested at all sites.  Respond to incidents of suspected compliance violations and takes appropriate actions as approved by Administration.
• Respond to Insurance and Government investigations and queries as requested.
• Provide reports on a regular basis and, as directed or requested, keep Site Manager informed of the operation and progress of compliance efforts.
• Maintain records of all reports, problems, and questions for review and reporting to Administration.
• Attend educational seminars/meetings and report information gathered to Site Managers.
• Develop and coordinate staff training and monitor staff attendance for compliance programs and requirements with HR.
• Maintain current knowledge about government and industry regulations and standards for the conduct of business.
• Detect, investigate, prevent and correct operational deficiencies relating to governmental and industry regulations and standards with Site Manager’s assistance. Ensure corrective action plans are in place to resolve any identified compliance issues.
• Provide timely feedback to employees and others on compliance issues.
• Maintain an effective reporting system to provide a uniform way for questions to be raised or potential non-compliance to be reported.
• Ensure patient confidentiality and follow HIPAA guidelines.
• Promote a professional image by adhering to the established dress code as listed in Employee Handbook.
• Check and resolve assigned tasks in EMR program.
• Assist co-workers as needed.
• Recognize when others are in need of assistance, information or directions and offers to help when able, or find someone who can.
• Responsible for neatness of work area to include stocking and cleaning.
• Be productive when faced with any “down time” during work hours.
• Maintain emotional control and diplomacy at all times.
• Maintain open and positive lines of communication.
• Adhere to company policies and procedures.
• Demonstrate sensible and efficient use of equipment and supplies by limiting waste, spoilage, or damage.

Performance Requirements:

Knowledge:

• Knowledge of federal, state, and local laws and regulations pertaining to the operation of a private clinic.
• Broad-based knowledge of relevant insurance regulations and familiarity with the Health Insurance Portability and Accountability Act (HIPAA).
• Understanding of coding and reimbursements systems, risk management and performance improvement.

Skills:

• Skill in exercising a high degree of initiative, judgment, discretion, and decision-making to achieve organizational objectives.
• Skill in analyzing situations accurately and taking effective action.
• Skill in establishing and maintaining effective working relationships with employees, patients, physicians, third-party payers, organizations and the public.
• Skill in exercising judgment and discretion in developing, applying, interpreting and coordinating departmental policies and procedures.
• Written and verbal communication skills.

Abilities:

• Ability to assume responsibility and exercise authority over assigned work functions.
• Ability to recognize, evaluate, solve problems, and correct errors.
• Ability to conceptualize work flow, develop plans and implement appropriate actions.
• Ability to communicate clearly and effectively orally and in writing.
• Ability to establish priorities and coordinate work activities.
• Ability to travel to all sites for monthly and/or quarterly audit and reviews.

Qualifications:
Bachelor’s degree, preferably with coursework in health care administration and compliance or comparable experience.

Physical Requirements:

• Ability to work effectively in a fast paced environment.
• Physical ability to sit, perform data entry and view computer screen for long periods at a time.
• Occasional exposure to communicable diseases and biohazards.
• Daily standing, walking, bending, and maneuvering.
• May require lifting up to 50 pounds or more to transfer and/or turn patient with and without assistive devices.

Travel Requirements: 

Travel may be required.

Scheduled Working Hours:

Normal work hours are 8:00 a.m. to 5:00 p.m., Monday through Thursday and 8:00 a.m. to 1:00 p.m. on Fridays. Hours may vary depending upon the needs of the position, department, and clinic.

Other Duties:

Please note this job description is not designed to cover or to contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change from time to time, with or without notice.

Equipment Operated:

Standard office equipment including: computers, printers, faxes, copiers, postage machine, etc.