Pathology Compliance Spec- Full Time- Day

Hackensack Meridian Health•Hackensack, NJ

14d

About The Position

The Pathology Compliance Specialist plans, coordinates, and implements processes specific to the pathology laboratory in collaboration with pathology section heads and the department’s medical and administrative leadership. The position develops and maintains the laboratory compliance plan, provides regulatory and compliance guidance, and evaluates the effectiveness of compliance activities. It supports laboratory management and staff in reducing exposure to fraud, abuse, negligence, and regulatory noncompliance. The role also investigates compliance concerns, audits, billing discrepancies, insurance denials, and issues involving laboratory information systems. It coordinates corrective actions and reporting, supports research compliance and clinical training affiliations, and serves as a liaison among laboratory teams, pathologists, hospital departments, corporate finance, compliance leadership, external regulators, and laboratory clients. The position maintains the laboratory charge master and supports outreach business pricing, contracts, and compliance.

Requirements

Bachelor’s degree in a healthcare-related science.
Minimum of 5 years of healthcare (hospital) experience.
Experience with clinical laboratory compliance guidelines for all regulatory agencies.
Excellent communication and presentation skills.
Ability to work independently.

Nice To Haves

Master’s degree in a healthcare-related science.

Responsibilities

Develop and implement employee and client training and education programs on compliance and HIPAA responsibilities in collaboration with the Vice President, Chief Compliance Officer.
Conduct and follow up on investigations of laboratory compliance issues reported through the compliance hotline, facilitate corrective action, and maintain confidential records and reports as appropriate.
Advise and support laboratory management and staff in improving systems to reduce or eliminate exposure to fraud, abuse, and negligence related to compliance.
Develop and maintain reports that help laboratory management and the Vice President, Chief Compliance Officer assess the effectiveness of the laboratory compliance program.
Develop and maintain a written laboratory compliance plan and laboratory-specific manual consistent with applicable laws, regulations, the corporate code of conduct, and related guidance.
Periodically coordinate evaluation of the laboratory compliance program and modify the compliance plan and manual as appropriate.
Develop and implement laboratory-wide communications that reinforce compliance program goals.
Investigate and resolve potential Cerner Millennium LIS and other laboratory information-system issues that could cause discrepancies with the hospital financial system; provide guidance on pre-analytic, analytic, and post-analytic testing and legal medical record documentation.
Investigate and resolve discrepancies in Medical Audit department submissions, monitor trends in testing-versus-billing discrepancies, and follow up as needed.
Monitor, investigate, and resolve insurance denials originating from laboratory billing and liaise with Patient Accounts.
Under the direction of the Administrative Director and Vice President, Chief Compliance Officer, liaise with external government and regulatory representatives on compliance activities.
Attend compliance coordinating team meetings and collaborate on compliance measurement systems and results reporting.
Develop an effective compliance program for the laboratory’s outreach activities.
Serve as a compliance liaison to pathologists and attend Pathology administrative group meetings.
Serve as the laboratory liaison to the Vice President, Chief Compliance Officer.
Analyze policies and research regulations relevant to laboratory policies and research processes.
Assist with implementing research study procedures and ensure laboratory research activities comply with IRB requirements and relevant GCP, FDA, and HIPAA guidelines.
Provide expertise to laboratory and research staff and others through consultation and liaison activities; review research budget proposals and billing of services.
Assess laboratory service requirements for research protocols in consultation with the test-performing section head and pathologist.
Attend regulatory education meetings and seminars related to research activities.
Establish clinical training affiliation agreements for University Medical Technology programs in consultation with legal counsel.
Coordinate clinical training requirements for Medical Technology and Phlebotomy students with affiliated schools.
Serve as the laboratory education liaison for the Hospital Health Science Academic Consortium.
Maintain working knowledge of laboratory and hospital computer systems and work with section heads and laboratory analysts to resolve related compliance issues.
Maintain and update the laboratory charge master, including annual CPT revisions and deletions.
Monitor billing claim denials daily and monthly and provide compliance guidance as needed.
Reconcile the Outpatient Exception Report daily.
Monitor the APC error log and serve as the laboratory liaison at finance denial meetings.
Serve as the laboratory liaison to Corporate Finance for laboratory business finance activities.
Conduct ongoing audits, monitoring, and investigations related to compliance with policies and regulatory requirements.
Lead meetings with departments or individuals to review audit reports and develop corrective action plans as necessary.
Initiate refunds related to audit findings as appropriate.
Perform other duties as required by the department.
Attend compliance and HIPAA seminars and conferences as requested, and attend laboratory in-services.
Adhere to the standards identified in the Medical Center’s Organizational Competencies.
Provide regulatory compliance guidance to Total Lab Outreach business clients and marketing and sales staff, and monitor the business unit’s compliance activities.
Establish pricing fee schedules and contracts for laboratory service clients.
Attend the Legal Medical Record Committee to support compliance with legal and regulatory guidelines for laboratory processes.
Administer and review laboratory research activities to meet organizational objectives and goals.