Compliance Analyst

St. Charles Health System•Bend, OR

18h

About The Position

Reporting to the Chief Compliance Officer, the Compliance Analyst’s primary role is to assess and monitor SCHS activities for compliance with applicable laws, regulations, ethical standards, and system policies and procedures. The compliance analyst is an experienced professional who develops and disseminates comprehensive resources, education and training programs, and coordinates activities to support compliance and operational policies and procedures. This position does not directly manage other caregivers, however, may be asked to review and provide feedback on the work of other caregivers.

Requirements

Bachelor’s degree in a Health Science, Business, Nursing, Health Information Management, or related field.
Healthcare Compliance or equivalent Compliance Certification (ex. CHC, CHRC, CHPC, CHC-F, or CCEP).
Valid Oregon driver's license and ability to meet SCHS driving requirements.
Ability to travel to business functions/trainings/meetings and all SCHS worksites.
Minimum five (5) years experience working in healthcare compliance.
Demonstrable legal research skills, with particular knowledge regarding state and federal statutory and regulatory law.
Experience working with Current Procedural Terminology (CPT) and related coding nomenclature and rules, ICD-10-CM coding conventions, and clinical documentation standards.
At least two (2) years’ experience working directly with physicians on professional fee billing compliance.
Communication/Interpersonal Strong interpersonal communication skills.
Ability to work under pressure in a fast-paced environment.
Ensures confidentiality 24/7/365.
Organizational Excellent organizational and multi-tasking skills.
Excellent communication and customer service skills.
Strong analytic and problem-solving skills.
Computer Proficient in Microsoft applications (Outlook, Word, Excel, and PowerPoint), database management, and document preparation.
Experience with Electronic Medical Record systems, Investigations, and Investigational Software.
Continually (75% or more): Use of clear and audible speaking voice and the ability to hear normal speech level.
Frequently (50%): Sitting, standing, walking, lifting 1-10 pounds, keyboard operation.
Occasionally (25%): Bending, climbing stairs, reaching overhead, carrying, pushing, or pulling 1-10 pounds, grasping/squeezing.
Rarely (10%): Stooping/kneeling/crouching, lifting, carrying, pushing, or pulling 11-15 pounds, operation of a motor vehicle.
Never (0%): Climbing ladder/stepstool, lifting/carrying/pushing, or pulling 25-50 pounds, ability to hear whispered speech level.

Nice To Haves

Additional experience in healthcare operations, finance or revenue integrity, quality or risk management, or human resources.
Experience with Epic EHR.

Responsibilities

Monitors and interprets federal, state, and local healthcare laws and regulations to ensure SCHS compliance. This includes laws and regulations pertaining to participation in the Medicare and Medicaid programs, fraud and abuse, patient privacy, and billing and coding.
Maintains knowledge of SCHS policies, procedures, and organizational standards and processes that support the seven elements of an effective compliance program as defined by the Office of the Inspector General.
Serves as a collaborative resource to SCHS leadership, employees, and medical staff on compliance-related topics and issues.
Identifies compliance risk through a collaborative risk assessment process with key stakeholders, including the Compliance Steering Committee, incorporating relevant information obtained through internal audits and investigations, the compliance hotline, the OIG work plan, and recent enforcement trends.
Receives, triages, and disseminates compliance-related notifications received from CMS, OHA, OCR, HRSA, and OIG. Supports the organizational response to those compliance-related notices as requested by the Chief Compliance Officer.
Assists in responding to regulatory investigations and periodic payor audits and assessments.
Investigates and responds to reports of legal, regulatory, or policy violations and other compliance concerns received from SCHS caregivers and others.
Works with leadership to recommend and establish policies and procedures to address legal, regulatory, and other compliance related matters.
Champions compliance as a core business principle and empowers caregivers and providers to speak up and do the right thing.
Identifies, and monitors, compliance trends and themes in data from complaint-driven investigations, routine and targeted audits, and related reports.
Participates in and serves on SCHS committees, collaborates with business, operational, legal and compliance stakeholders, and supports all compliance related processes and activities, including without limitation, monitoring 340B program activities, OIG exclusion list compliance, annual compliance education & training, and OIG Audit Plan risk assessments.
Partners with members of the compliance department, including privacy officers, internal auditors, and other compliance staff, to design the annual compliance, privacy, and audit plans.
Creates and maintains appropriate documentation of all compliance activities.
Provides system level leadership to establish and maintain open lines of communication within the organization to encourage the prompt reporting of compliance concerns.
Develops, executes, and manages detailed project plans and status reports.
Serves as the Revenue Integrity & refund liaison.
Supports the vision, mission, and values of the organization in all respects.
Supports the Lean principles of continuous improvement with energy and enthusiasm, functioning as a champion of change.
Provides and maintains a safe environment for caregivers, patients, and guests.
Conducts all activities with the highest standards of professionalism and confidentiality.
Complies with all applicable laws, regulations, policies, and procedures, supporting the organization’s corporate integrity efforts by acting in an ethical and appropriate manner, reporting known or suspected violation of applicable rules, and cooperating fully with all organizational investigations and proceedings.
Delivers customer service and/or patient care in a manner that promotes goodwill, is timely, efficient, and accurate.
May perform other duties of similar complexity within the organization, as required or assigned.