Compliance Specialist (Clinical)

LifeCare Home Health•Irving, TX

10d

About The Position

The Compliance Specialist is responsible for assisting with the development and implementation of the compliance audit program to ensure regulatory adherence, risk mitigation and operational integrity. This role ensures that Lifecare Home Health Family complies with federal and state laws and regulations and internal policies by identifying potential risks and working cross-functionally to implement corrective actions. The Compliance Specialist will lead risk assessments, internal audits and compliance investigations while collaborating with leadership to mitigate risks and strengthen internal controls.

Requirements

Extensive knowledge of hospice Local Coverage Determinations (LCDs)
2+ years of compliance auditing, internal audit or regulatory compliance experience.
Extensive knowledge of audit methodologies, internal controls and risk assessments.
Strong understanding of healthcare fraud, waste, and abuse prevention, coding compliance, and billing practices within the context of hospice care.
Experience in healthcare, finance, billing, coding, compliance and government regulations.
Ability to build relationships with internal and external stakeholders, including leadership, clinical teams, providers, payers, and regulatory bodies.
At least one of the preferred certifications or the ability to obtain certification within 1 year of employment is required.
Experience working collaboratively with regulatory agencies, auditors, and healthcare providers to ensure compliance with hospice requirements.
Strong analytical and problem-solving skills, with the ability to identify compliance risks, assess organizational performance, and develop actionable solutions.
Ability to pass DHS background study.
Excellent verbal and written communication skills with the ability to clearly communicate complex compliance issues to senior executives and staff members at all levels.

Nice To Haves

RN with hospice or homecare governmental audit (Additional Documentation Requests (ADRs) experience strongly preferred.
Will consider associate’s degree in Business Administration, Finance, Accounting, Healthcare Administration, or a related field.
Additional certifications in healthcare compliance, law, privacy, data security, or information management are a plus.
Preferred Certifications: Certified Hospice & Palliative Care Nurse (CHPN) Certified in Healthcare Compliance (CHC) Certified Internal Specialist(CIA) Certified Billing and Coding Specialist (CBCS) Certified Professional Coder (CPC) Certified Professional Medical Specialist(CPMA) Certified Compliance and Ethics Professional (CCEP)

Responsibilities

Governmental Additional Documentation Requests (ADRs) Responses timely and accurately to governmental audits for hospice and homecare
Prepares and tracks appeals processes
Assist with the development and implementation of a comprehensive compliance audit program tailored to meet the requirements of CMS, Medicaid, Medicare, Medicare Advantage plans, other government payors, private insurers, the Office of Inspector General (OIG) and the Department of Justice (DOJ).
Develop audit frameworks, methodologies and policies that align with regulatory requirements and best practices within healthcare.
Ensure audits are thoroughly documented and findings are reported with corrective action recommendations.
Assist with the establishment of a continuous monitoring system for compliance risks and policy effectiveness.
Assist with enterprise-wide risk assessments to identify gaps with federal and state laws and regulations and internal policies.
Conduct risk-based audits to assess the effectiveness of internal controls and adherence to internal policies.
Develop risk mitigation strategies and ensure corrective action plans are implemented.
Collaborate with departments such as Legal, Human Resources, Finance, IT, Quality, Billing and Coding to enhance internal controls and address and remediate compliance risks.
Provide guidance to operational teams on improving processes to ensure compliance with federal and state laws and regulations and internal policies.
Monitor emerging regulatory trends and enforcement actions to proactively address potential risks.
Draft and update audit related policies, procedures and guidelines.
Provide guidance on internal controls, regulatory requirements and audit best practices.
Develop and deliver compliance audit training and education to employees on regulatory requirements, compliance best practices and audit procedures.
Oversee internal investigations related to risk assessment and/or audit findings, conducting root cause analysis to identify trends or patterns of non-compliance.
Develop corrective action plans (CAPs) and track their implementation.
Ensure confidentiality and integrity in all investigations and reporting.
Work closely with Legal, Human Resources and Risk Management teams to conduct investigations and recommend disciplinary action, as applicable.
Ensure compliance with relevant federal and state regulations including, but not limited to, HIPAA, Stark Law, Anti-Kickback Statute, OIG Guidelines, CMS, OSHA and DOJ.
Oversee regulatory reporting requirements and respond to inquiries from auditors, regulators and enforcement agencies, collaborating with Lifecare Home Health Family leadership and General Counsel.
Prepare audit reports, present findings and recommended corrective actions to executive leadership, the Compliance Committee and the board of directors.
Serve as a trusted advisor to the Chief Compliance Officer, executive team and leadership.
Foster a culture of compliant and ethical behavior across the organization.
Collaborate with key stakeholders.
Support external auditors and regulatory agencies during compliance reviews and investigations.
Performs other duties as assigned.