Compliance Coordinator

This is a fully remote position, open to applicants in New York.

📋 Description

• Perform Corporate Compliance audits, investigations, and training across all affiliates.

• Advise system administration and RGHS management on adherence to laws, regulations, and contractual obligations.

• Act as a subject matter expert in building and enhancing the EMR, focusing on clinical documentation, workflows, and impacts on the revenue cycle.

• Independently manage projects, prepare governmental disclosures, and facilitate external regulatory audits.

• Organize and execute audits related to the revenue cycle, financial statements, payments, attestations, grants, employees, contractors, and payment agreements.

• Conduct interviews with staff to determine the root causes of compliance issues.

• Work collaboratively with healthcare professionals to discuss findings and provide compliance education.

• Create audit reports and present results to the Compliance Director, RGHS Administration, and management.

• Formulate corrective action plans and assist in their implementation.

• Carry out follow-up audits to assess the effectiveness of monitoring efforts.

• Analyze studies from government and professional associations to identify risks and opportunities.

• Establish compliance benchmarks and conduct risk assessments.

• Keep track of changes in regulations that impact departments.

• Research and aid in obtaining approvals for new business development.

• Support initiatives aimed at margin improvement while ensuring compliance.

• Design and implement training programs focused on Fraud, Waste and Abuse, revenue-cycle documentation, coding, charging, billing, and denial appeals.

• Conduct and oversee internal investigations related to non-compliance, fraud, waste, and abuse.

• Facilitate corrective actions and monitor affected departments.

• Manage and facilitate external investigations conducted by OIG, DOJ, OMIG, FBI, Medicare, and third-party payer fraud units.

⛳️ Requirements

• AAS or BS in Health Information Management, Health Care Administration, Finance, or Accounting, along with experience in healthcare compliance; a combination of healthcare work experience, credentials, and/or education will be considered.

• At least five years of experience in healthcare relating to CMS and local payer regulations.

• RHIT, RHIA, CCS, or CCS-P certification is preferred.

• Relevant healthcare-related certification or other experience may be accepted in place of the aforementioned certifications.

• Compliance Board Certification is a plus.

• Excellent communication, analytical, project management, and training abilities.

• High attention to detail, critical thinking, decision-making skills, professionalism, and the capacity to manage confidential and sensitive information.

• Familiarity with local, state, and federal laws and regulations, contractual obligations, CMS, and payer regulations.

• Availability to work Monday to Friday, from 8:00 am to 4:30 pm.

• Capable of sedentary work, including prolonged sitting and computer use.

🏝️ Benefits

• Comprehensive health benefits package.

• Opportunities for professional development and training.

• Flexible work environment.

• Competitive salary and performance-based incentives.