Compliance Specialist, Senior

Fred Hutchinson Cancer Center • Seattle, WA

9d

About The Position

The Compliance Specialist, Senior works within Fred Hutchinson Cancer Center’s Compliance Office and reports to the Compliance Director. The role collaborates with Revenue Cycle, Quality, Pharmacy, Laboratory, and other enterprise partners to support compliance with applicable laws, regulations, and organizational policies. The specialist plans and conducts compliance audits and serves as a content expert for health care reimbursement and billing compliance activities.

The position responds to inquiries and complaints, investigates issues, prepares audit reports, develops and delivers education and outreach, reports on program activities, maintains records, monitors regulatory developments, and assists with creating and reviewing policies and procedures. In coordination with internal and external stakeholders, the specialist helps establish and maintain a health care reimbursement and billing compliance risk assessment, auditing, and reporting program.

Requirements

• Bachelor's degree.
• At least five years of experience related to health care reimbursement or coding operations or compliance.
• Experience conducting internal audits or hospital billing and coding audits and preparing written reports of findings.
• Extensive knowledge of ICD-9-CM, ICD-10-CM, CPT, and HCPCS coding principles and guidelines.
• Strong critical-thinking and data-analysis abilities, including the ability to gather information from multiple sources and use sophisticated data-mining programs and software to understand problems and issues.

Nice To Haves

• Certified Professional Coder - Hospital (CPC-H) and/or Certified Medical Audit Specialist (CMAS).
• Experience using software tracking mechanisms for compliance issues.
• Understanding of the revenue cycle and clinical trial/research billing processes.
• Extensive knowledge of compliance program requirements, principles, and guidelines.

Responsibilities

• Conduct independent and integrated compliance audits and investigations to support the Compliance Office’s auditing and monitoring plan.
• Receive and respond to inquiries, consultation requests, and complaints.
• Prepare written reports of audit findings and results, including recommendations for improvement and corrective actions such as refunding identified overpayments.
• Assist with tracking and conducting health care reimbursement compliance risk assessments, identifying high-risk areas, and communicating results to Compliance Leadership, Health Care Reimbursement Compliance.
• Assist in developing, implementing, and maintaining clinical and research reimbursement and coding compliance education, training, and internal controls, including policies and procedures.
• Develop standard compliance reports to communicate findings and highlight trends.
• Report on compliance activities to the Senior Manager for further distribution as needed.
• Maintain working knowledge of current health care compliance issues, OIG enforcement activities, and applicable regulations, including HIPAA, licensure requirements, and quality standards.
• Perform other duties as assigned.

Benefits

• Medical and vision coverage
• Dental coverage
• Flexible spending accounts
• Life insurance
• Disability coverage
• Retirement benefits
• Family life support
• Employee assistance program
• Onsite health clinic
• Tuition reimbursement
• Paid vacation of 12–22 days per year
• Paid sick leave of 12–25 days per year
• 13 paid holidays per year
• Paid parental leave of up to 4 weeks

What This Job Offers

• Job Type: Full-time
• Career Level: Senior