Compliance Specialist

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

📋 Description

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

• Provide education to providers on government regulations, CMS guidelines for academic medical centers, HIPAA, and fraud and abuse.

• Evaluate current conditions and suggest priorities and objectives for upcoming clinic requirements.

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

• Carry out timely routine internal audits of provider documentation.

• Work in collaboration with physicians and internal staff to enhance documentation, coding, and compliance capabilities.

• Assess internal controls, policies, and procedures to ensure compliance with university, state, and federal regulations, as well as sound business and finance practices, and clinical objectives.

• Address external and internal issues and implement corrective actions.

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

• Advocate for compliance initiatives within clinical faculty and administration.

• Mitigate institutional and individual provider legal and financial risks through education and internal audits.

• Execute other related duties incidental to the responsibilities outlined.

⛳️ Requirements

• Bachelor's degree.

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

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

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

• For professional coding, certifications such as CPC, CCS, RHIT, RHIA, or CPMA are required.

• Experience in formal or informal teaching of coding is preferred.

• Specialty coding experience in surgical or E/M coding is preferred.

• Familiarity with government regulations, CMS guidelines for academic medical centers, HIPAA, fraud, and abuse.

• Strong organizational, analytical, and communication skills.

• Capability to conduct coding and billing risk reviews, internal audits, and corrective actions.

• Proficiency in reviewing internal controls, policies, and procedures for compliance with university, state, and federal guidelines.

• Ability to effectively communicate with Medicare/Medicaid carriers and third-party payers.

🏝️ Benefits

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

• 100% remote work opportunity.

• Commitment to equal employment opportunity.

• Information and provisions for reasonable accommodations.