PS Clinical Compliance Officer

The University of Utah•Salt Lake, UT

22d•Remote

About The Position

The Regulatory Compliance Administrator collaborates with providers, managers, and staff to assist departments, clinics, and/or service lines in implementing, coordinating, and monitoring compliance practices. This incumbent is responsible for conducting medical necessity audits by reviewing clinical practice standards and documentation. The incumbent will conduct and respond to audits and projects related to regulatory and payment integrity to ensure accurate and timely responses to governmental contractors. In addition to the clinical expertise needed for the medical necessity reviews, the incumbent will perform scheduled and unscheduled regulatory and payment integrity audits, develop and standardize policies and procedures, training and education, compliance investigations, and reporting to ensure compliance with University, State, and Federal guidelines. The incumbent must be highly skilled in time management and possess strong communication skills. The incumbent will work with their team to evaluate and review individual skills and knowledge level and assign tasks accordingly. Must be able to provide mentoring to supporting roles within the team. This position is not responsible for providing patient care. This position has the possibility of remote work.

Requirements

Three to five years of clinical experience in a patient care capacity is required. Patient care experience may be substituted with equivalent years of experience in medical necessity review.
Current medical licensure through DOPL (or equivalent state agency) such as, but not limited to: RN, BSN , NP, PA, etc preferred.
Must be proficient with word processing, spreadsheet, and related computer applications and have exemplary human relations and effective communication skills.
Requires a sound knowledge of clinical practice and exceptional critical thinking and leadership abilities.
Applicants must demonstrate the potential ability to perform the essential functions of the job as outlined in the position description.

Nice To Haves

Department may require coding certification ( CPC , ACS , CCS -P/H, RHIA , or RHIT ).

Responsibilities

Maintains current knowledge regarding federal and state guidance, organizational needs, and regulations.
This position prioritizes governmental and internal audit requests and needs based on risk, timelines, and available skilled personnel.
Reviews documentation for medical necessity and utilizes industry standard tools such as InterQual or Milliman.
Teams with providers and staff to assist departments in implementing compliance practices and monitors and coordinates those activities with the departments.
Assists the University in preparing and completing regulatory audits by developing, monitoring, and updating quality controls and recommending actions to maintain compliance.
Oversees, coordinates, and conducts audits/investigations to ensure compliance with University, State, and Federal guidelines.
Analyzes and documents compliance processes.
Recommends enhancements to policies and procedures for compliance review.
Designs and implements training and education programs to enhance compliance awareness.
Serves as an expert resource in compliance issue resolution.