PeaceHealth - Vancouver, WA
PeaceHealth is seeking a Healthcare Compliance Specialist - Organizational Integrity for a 1.0 full time equivalent Exempt position. This position will be working Day shift with shift durations of 8 Hours.
Req ID: 178666
Assists in developing and maintaining the Healthcare Compliance Program for PeaceHealth in accordance with the Department of Health and Human Services (DHHS) Office of Inspector General’s (OIG’s) Voluntary Guidelines for Hospital Compliance in 1998, the Supplemental Hospital Guidelines in 2005, Third-Party Medical Billing Companies in 1998, and other federal and state regulations. Works to prevent, detect and correct compliance risks through the development and distribution of written policies and procedures and effective compliance training. Develops and maintains effective lines of communication; responds to detected offenses, develops corrective action plans related to non-compliance.
1. Assists in the development, implementation, and maintenance of the Healthcare Compliance Program for PeaceHealth. Develops and writes policies and procedures that establish standards for compliance, giving specific guidance to management, operational leadership, and departments.
2. Performs audits to determine compliance with federal, state and healthcare billing requirements. Evaluates the adequacy and effectiveness of internal and operational controls. Communicates audit results to hospital service departments, departmental leadership, and other appropriate staff, and provide education. Makes recommendations for management corrective action and follows up on their timely completion.
3. Identifies and works with operational staff to determine healthcare compliance metrics. Works with other healthcare compliance staff to help develop ongoing monitoring plan.
4. Evaluates the adequacy, compliance and accuracy of documentation in support of services billed.
5. Acts as a resource to clinical areas on compliance, documentation and coding issues. Researches laws, rules and regulations, obtains legal advice as appropriate; Assists with implementation of action plans and process improvements.
6. Assists newly-credentialed/privileged physician and non-physician providers with assessing clinical activities and determining billable services. Reviews clinical services performed by providers to assure compliance. Seeks legal advice as necessary. Educates providers concerning laws and regulations and applicability to PeaceHealth.
7. Participates in the Healthcare Compliance Program planning, including risk assessments and audit planning with annual and quarterly time lines.
8. Responds to external audits and government investigations.
9. Represent the department on committees and task forces and in various meetings. May lead compliance projects, conduct investigations, and chair task forces/committees.
10. Performs other duties as assigned.
EDUCATION: Bachelor’s degree or equivalent knowledge and skills obtained through a combination of education, training and experience.
Minimum of five years compliance experience (within compliance or clinical departments) and/or coding in a healthcare setting required.
Medical records management experience preferred.
Clinical experience preferred.
LICENSE/CERTIFICATION: Certified Healthcare Compliance (CHC) required. Must obtain certification within 18 months from hire date if not obtained at time of hire.
Strong interpersonal skills and evidence of previous success in dealing with staff at all levels, including nurses, non-physician practitioners, physicians, and management.
Strong presentation skills and ability to interact with all levels of leadership across the PeaceHealth continuum.
Knowledge of Medicare and Medicaid documentation and coding rules and guidelines.
Knowledge of healthcare compliance audit methodologies, principles and techniques.
Ability to interpret and apply documentation and coding rules and regulations, facility fee charge capture and reimbursement methodologies.
Clear, intentional and strategic communicator.
Demonstrated proactiveness and ability to work independently and self-directed in managing multiple concurrent projects.
Excellent analytical and problem solving skills.
Advanced skills in all MS Office applications (Word, Excel, Outlook, PowerPoint).
REGIONAL/LOCATION SPECIFIC NOTES: May need to travel to off-site PeaceHealth locations as necessary.
Please apply online to be considered. For full consideration of your skills and abilities, please attach a current resume with your application.
PeaceHealth, based in Vancouver, Wash., is a not-for-profit Catholic health system offering care to communities in Washington, Oregon, and Alaska. PeaceHealth has approximately 16,000 caregivers, a multi-specialty medical group practice with more than 900 providers and 10 medical centers serving both urban and rural communities throughout the Northwest. In 1890, the Sisters of St. Joseph of Peace founded what has become PeaceHealth. Today, PeaceHealth is the legacy of its founding Sisters and continues with a spirit of respect, stewardship, collaboration and social justice in fulfilling its Mission.
We offer competitive compensation, a robust benefits package and a collaborative, Mission-driven work environment! To learn more about working at PeaceHealth and the Vancouver community please visit our homepage: www.peacehealth.org/careers.
Location: Vancouver, Shared Services Center (802)
Job Category: Business, Administrative & Facilities
Shift Length: 8 Hours
Work Type: Full Time
PeaceHealth is committed to providing equal employment opportunities to all qualified job applicants and employees without regard to the following statuses: protected veteran; qualified individual with a disability; race; ethnicity; religion; gender; pregnancy; gender identity; national origin; age; genetic information; sexual orientation; or any other protected status in accordance with local, state, or federal laws.
The above information is intended to indicate the general nature and level of work performed by this position. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of caregivers assigned to this job.
Posting Notes: Vancouver || Business, Administrative & Facilities || Risk Management & Quality || Full Time || ORG INTEGRITY
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