Compliance Specialist

Compliance Auditor

The incumbent is responsible to conduct coding, billing and documentation audit and monitoring activities for Monument Health facilities. Auditing and monitoring activities will be completed in a timely and professional manner as outlined in the Corporate Responsibility Audit Manual. The incumbent will also help to prevent, detect and resolve instances of conduct that do not conform to Monument Health policies or federal and state laws and regulations.

Essential Functions :

• Conducts compliance reviews including documentation and / or coding audits and monitoring activities, review of medical records, contracts, or other relevant information.
• Consistently applies the current and appropriate regulatory standards to medical services.
• Consistently develops and assists with the development and / or delivery of timely and professional compliance education.
• Assist with the development, implementation, maintenance and revision of compliance policies and procedures.
• Communicate new or revised regulations and guidelines to department managers, staff, physicians and administration.
• Identify potential areas of compliance vulnerability and risk, develop and implement corrective action plans for resolution of problematic issues, and provide general guidance on how to ensure compliance on a consistent basis and documents accordingly.
• Assists with the development of strategies that promote regulatory compliance, best practices, and positive survey outcomes.
• Develops criteria for setting priorities and consistently prioritizes these systematic reviews so as to address the departments with the most significant impact.
• Maintains appropriate documentation and communicates results of audits and compliance investigations / reviews in a clear, concise and logical manner.
• All other duties as assigned.

Additional Requirements :

Preferred : Experience - 1+ years of Coding Experience; 3+ years of Healthcare Experience Education - Bachelors degree in Business or Healthcare Certification - Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA) or Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC)

Physical Requirements : Sedentary work - Exerting up to 10 pounds of force occasionally and / or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.