Compliance Specialist

This is a fully remote position, open to applicants in Alabama, +22 more states.

📋 Description

• Develop and uphold compliance programs aligned with the Office of Inspector General's operational plan.

• Mitigate legal and financial risks for institutions and individual providers through training and internal auditing.

• Provide education to providers regarding government regulations, including guidelines from the Centers for Medicare and Medicaid, HIPAA, and issues related to fraud and abuse.

• Evaluate current circumstances and propose priorities and objectives for the future needs of the clinic.

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

• Carry out regular internal audits of provider documentation.

• Partner with physicians and internal teams to enhance documentation, coding, and compliance capabilities.

• Review internal controls, policies, and procedures to ensure compliance with university, state, and federal standards.

• Address external and internal inquiries and put corrective actions into place.

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

• Advocate for compliance initiatives among clinical faculty and administration.

• Execute other related tasks as necessary for the role.

⛳️ Requirements

• A bachelor's degree is required.

• A minimum of four years of administrative experience applying compliance, coding, and auditing principles in insurance billing, collections, consulting, and other revenue cycle operations.

• For technical coding, at least two of the four years of experience must involve DRGs and APR-DRGs.

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

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

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

• Preference given to candidates with experience in formal or informal coding education.

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

• Strong organizational, analytical, and communication skills are needed.

• Capability to conduct coding, documentation, compliance, and internal auditing assessments.

• Candidates must reside in one of the following states: 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

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

• A fully remote work arrangement.

• Commitment to equal employment opportunities and nondiscrimination.

• Information and provisions regarding reasonable accommodations.