Health Care Compliance Specialist II

Virginia Information Technologies Agency • Danville, VA

4d

About The Position

Assist and oversee in the planning, development, implementation, monitoring,
education, and training to promote a Medicare Voluntary Compliance Program and
related Risk Management and Quality Improvement programs.
Works with Utilization Management Coordinator to ensure compliance with
applicable CMS Conditions of Participation.

Requirements

• Licensed and in good standing as a Registered Nurse. License must remain active and in good standing throughout employment.
• Clinical/direct care delivery experience in an inpatient psychiatric setting required.
• Previous experience in a healthcare setting required.
• Experience in the compliance profession to include investigations and health information management required.
• Knowledge of 1) Medicaid and Medicare administration policies and practices, 2) Clinical Documentation, 3) Administration and training principles and practices, 4) Applicable Federal, State, and Departmental laws, regulations and policies
• Skills include: 1) Problem Identification, 2) Information Gathering, 3) Organization, 4) Critical Thinking, 5) Interpersonal Diplomacy/Professionalism.
• Knowledge of inpatient psychiatric treatment and documentation required, to include interdisciplinary treatment planning, discharge planning, and psychosocial rehabilitation.
• Functionally adept at working within EHR system –Millennium.
• Ability to communicate effectively, both verbally and in writing, with clinicians, administrators, and Individuals.
• Ability to assist with utilization management principles, third party reimbursement systems, and associated legal/regulatory requirements.
• Basic computer skills in typing, Microsoft Word, and Microsoft Excel.
• Ability to write policies, procedures, and instructional tools; design forms; and produce memorandums, agendas, and minutes.
• Ability to work independently to include organization, prioritization, and maintain timelines of multiple tasks/projects.

Nice To Haves

• Experience assisting with regulatory surveys, i.e. The Joint Commission (TJC), CMS, VDH, OSIG.
• Veterans and people with National Service.
• Bilingual fluency in Spanish and English.

Responsibilities

• Assist and oversee in the planning, development, implementation, monitoring, education, and training to promote a Medicare Voluntary Compliance Program and related Risk Management and Quality Improvement programs.
• Works with Utilization Management Coordinator to ensure compliance with applicable CMS Conditions of Participation.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 1-10 employees