Pathology Compliance Spec- Full Time- Day

Hackensack Meridian Health • Hackensack, NJ

1d • Onsite

About The Position

The Pathology Compliance Specialist is responsible for planning, coordinating and implementing all aspects of the processes specific to the area. This is accomplished in conjunction with Pathology section heads, the medical and administrative leadership of the department.

Requirements

• Bachelor's degree in healthcare related science.
• Minimum 5 years healthcare (hospital) experience.
• Experience with clinical laboratory compliance guidelines for all regulatory agencies.
• Must have excellent communication and presentation skills.
• Must be able to work independently.

Nice To Haves

• Master's degree in healthcare related science.

Responsibilities

• Develops and implements appropriate employee and client office training and education programs in collaboration with the Medical Center's Vice President, Chief Compliance Officer, to ensure that same are aware of their compliance and HIPAA responsibilities and to encourage high standards of compliance performance throughout the Laboratory.
• Conduct and follow ups investigations and facilitates corrective action as needed in consultation with the Administrative Director and Vice President, Chief Compliance Officer with regard to laboratory compliance issues communicated through the compliance hotline. This may include the development and maintenance of appropriate, confidential records and reports.
• Provides advice and support to laboratory management and staff in efforts to continually improve systems to reduce and eliminate exposure to fraud, abuse and negligence actions related to compliance.
• Develops and maintains appropriate reports to provide information needed by laboratory management and the Vice President, Chief Compliance Officer to continually assess the effectiveness of the laboratory compliance program.
• Develops and maintains a written laboratory compliance plan to include a written laboratory specific manual, consistent with applicable law and regulation, corporate code of conduct, and other related policy and administrative guidance.
• Coordinates a comprehensive evaluation of the effectiveness of the laboratory compliance program periodically and modifies the compliance plan and manual as appropriate.
• Develops and implements consistent, laboratory wide communication that reinforces the goals of the Compliance program in a positive way and maintains momentum to strive for excellence in compliance performance.
• Investigates and resolves potential issues with the Cerner Millennium system (LIS) and any relevant laboratory information systems that might cause discrepancies as it relates to the hospital financial system. Provides compliance guidance for issues related to laboratory pre-analytic, analytic and post-analytic testing and legal medical record documentation.
• Investigates and resolves discrepancies of audits submitted by the Medical Audit department, and monitors trends in discrepancies of testing vs. billing, and follows up accordingly.
• Monitors, investigates and resolves insurance denials originating from lab billing and acts as the liaison between the lab and Patient Accounts for resolution.
• Under the direction of the Administrative Director and the Vice President, Chief Compliance Officer, acts as liaison to outside government and regulatory representatives in compliance related activities.
• Attends compliance coordinating team meetings, Collaborates with appropriate team members to evaluate, develop, implement and oversee effective compliance measurement systems and results reporting.
• Develops an effective compliance program for the outreach specific aspects of the laboratory.
• Acts as liaison to the pathologists for compliance related activities. Attends meeting of the Pathology administrative group.
• Acts as the laboratory liaison to the the Vice President, Chief Compliance Officer.
• Analyzes policies and research regulations for laboratory policies and processes related to research activities.
• Assist with implementation of research study procedures. Ensuring all laboratory related research activities adhere to IRB requirements including relevant GCP, FDA , and HIPAA guidelines.
• Provides expertise to laboratory, research staff and others through consultation and liaison activities. Reviews department research budget proposals and billing of services.
• Assesses needs of laboratory service requirements through review of all relevant research protocols with test performing section head and pathologist.
• Attends regulatory educational meetings and seminars related to research activities.
• Establishes clinical training affiliation agreements in consultation with legal counsel for all University Medical Technology programs.
• Coordinates clinical training requirements of Medical Technology Program and Phlebotomy Programs students with all affiliated schools.
• Acts as the laboratory education liaison for the Hospital Health Science Academic Consortium.
• Possesses a thorough working knowledge of the laboratory and hospital computer systems and works closely with the section head and laboratory analysts to resolve compliance issues as it relates to those systems.
• Maintains and updates the laboratory charge master including annual CPT revisions, deletions, etc.
• Monitor billing claim denials on a daily and monthly basis and provide compliance guidance as needed.
• Reconciles the Outpatient Exception Report daily.
• Monitors the APC error log and acts as the liaison for the laboratory on the finance Denial Meetings.
• Acts as the laboratory liaison to the Corporate Finance Department for laboratory business finance activities.
• Conducts ongoing auditing, monitoring, and/or investigations related to compliance with policies and regulatory requirements.
• Leads and conducts meetings with respective departments or individuals to review audit reports and develop corrective action plans as necessary.
• Initiates any pertinent refunds related to audit findings.
• Performs other duties as required by the department.
• Attends compliance and HIPAA seminars and conferences as requested.
• Attends laboratory in services.
• Adheres to the standards identified in the Medical Center's Organizational Competencies.
• Provides compliance regulatory guidance for Total Lab Outreach business clients and marketing and sales staff. Monitor compliance activities of business unit.
• Establishes pricing fee schedules and contracts for laboratory service clients.
• Attends the Legal Medical Record Committee to ensure legal regulatory guidelines and compliance of laboratory related processes.
• Administers and reviews laboratory research activities to meet organizational objectives and goals.

Benefits

• EXCELLENT benefits
• Scheduling Flexibility
• Tuition Reimbursement
• Employee Discounts
• health, dental, vision, paid leave, tuition reimbursement, and retirement benefits

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees