Compliance Specialist

This is a fully remote position, open to applicants in Alabama, +21 more states.

📋 Description

• Develop and uphold compliance programs in line with the Office of Inspector General's work plan.

• Provide education to providers on government regulations, Medicare and Medicaid guidelines, HIPAA, fraud and abuse, as well as compliance updates.

• Assess current conditions and suggest priorities and objectives for the future needs of the clinic.

• Identify areas of risk related to coding and billing, perform targeted reviews, and initiate corrective measures.

• Carry out timely routine internal audits of provider documentation.

• Work collaboratively with physicians and internal personnel to enhance documentation, coding, and compliance capabilities.

• Evaluate internal controls, policies, and procedures to ensure adherence to university, state, and federal regulations, as well as sound business and financial practices.

• Address internal and external inquiries swiftly and implement necessary corrective actions.

• Liaise with Medicare/Medicaid carriers and third-party payers regarding policies and procedures.

• Advocate for compliance initiatives among clinical faculty and administration.

• Perform additional duties related to the responsibilities outlined above.

⛳️ Requirements

• Bachelor's degree.

• Four years of administrative experience applying compliance, coding, and auditing principles to insurance billing, collections, consulting, and related revenue cycle functions.

• For technical coding roles, a minimum of two out of the four years of experience with DRGs and APR-DRGs is mandatory.

• RHIA, RHIT, or CCS certification is required for technical coding.

• For professional coding positions, experience in specialty coding for surgical or E/M coding is preferred.

• CPC, CCS, RHIT, RHIA, or CPMA certification is required for professional coding.

• Strong organizational, analytical, and communication skills.

• Familiarity with government regulations, Centers for Medicare and Medicaid guidelines, HIPAA, fraud and abuse, coding, billing, auditing, and compliance is essential.

• Remote employees must reside in North Carolina, Alabama, Arizona, Connecticut, District of Columbia, Florida, Georgia, Illinois, Iowa, Kentucky, Louisiana, Maine, Michigan, Missouri, Montana, New Hampshire, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, or Washington.

🏝️ Benefits

• $10,000 sign-on bonus distributed in four equal installments over 24 months, at six-month intervals.

• Fully remote work arrangement.

• Reasonable accommodation provisions available.

• Commitment to equal opportunity and nondiscrimination.