Compliance Analyst

About the Role :

The Compliance Analyst will work under the direct supervision of the Senior Manager of Compliance, primarily to conduct research and analyze large datasets from various sources to prevent potential fraud, waste, and abuse.

The Compliance Analyst will conduct reviews and assessments across multiple services lines to ensure adherence to state and federal regulations.

This position will work as a liaison to assist in communicating with other Central Services departments such as Revenue Cycle Management and Legal.

This role serves as a Sound remote colleague liaison for helping to mitigate risk such as inappropriate disclosure of PHI and / or other HIPAA violations along with responding to regulators and communicating with vendors.

This position is both a client-facing position and an internal colleague-facing position. Sound Physicians contracts with over 250 individual hospitals.

This position functions to ensure compliance with Federal and State laws, and to ensure that Sound functions within the confines of each Business Associate Agreement (BAA), meeting all contractual and regulatory obligations.

The Details : Remote,

In this role, you will be responsible for :

Demonstrates the ability to communicate effectively regarding billing and documentation policies, procedures, and regulations;

obtains clarification of conflicting, ambiguous, or non-specific information.

• Uses relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards.
• Absorbs information and forms general rules or conclusions (including finding relationships among seemingly unrelated events) and applies general rules to specific problems to produce answers that make sense.
• Researches and responds to compliance inquiries, working closely with the Senior Manager of Compliance on Risk Assessments.
• Files regulatory reports and other documentation using our reporting tool, Navex.
• Reviews and assesses potential fraud activity and develops fraud detection tools.
• Audits medical record documentation to identify coding variances; prepares reports of findings; creates a plan for next steps.
• Acts as a liaison and / or facilitates communication with other Central Service teams.
• Maintains clear and consistent communication.
• Monitors system outputs for integrity and error identification and reports all errors to management.
• Performs problem resolution, including analysis and troubleshooting.
• Project Management skills required to maintain organization and report out weekly to management on the status of current projects.
• Maintains strict confidentiality about protected health information. Understands and adheres to Sound’s HIPAA Privacy & Security policies and procedures.

What we are looking for : A successful candidate will have a demonstrated track record of a combination of these values, knowledge, and experience :

Values :

• Coachable - Demonstrates a willingness to accept feedback from others and put it into practice.
• Resourceful - Proactive willingness to utilize available information and tools to figure things out.
• Persistent - Demonstrates the ability to keep at it even when obstacles or challenges are present; returns to the work at hand after a change of course.
• Self-Starter - Demonstrates the ability to jump in and start a task or project with limited direction.
• Strategic Thinker - Demonstrates the ability to look at the big picture and proactively develop a plan of action.
• Trustworthy - Demonstrates a high degree of integrity; keeps confidences; does what they say they will do.
• Customer Focused - Puts customer (internal and external) needs first and makes customers their top priority.

Knowledge :

• High school Diploma or GED certificate.
• Excellent analytical and critical-thinking skills.
• Excellent organizational skills.
• Excellent written and oral communication skills.
• Strong interpersonal skills.
• Creative and persistent problem solver.
• Client service-oriented (both internal and external).
• Ability to multi-task and prioritize workload in a fast-paced environment.
• Ability to clearly communicate medical coding information.
• Knowledge of auditing concepts and principles.
• Knowledge and understanding of professional fee coding (CPT and ICD 10), physician group practice revenue cycle processes, regulatory compliance issues related to billing and coding, documentation standards, and third-party payer processes.
• Ability to use independent judgment and to manage and impart confidential information.
• Ability to adapt, modify and prioritize audit functions as required.
• Coding Certification required (Any of CPC, CPC-H, CCS, CCS-P).

Experience :

• 1 year of experience coding Evaluation and Management services.
• 1 year experience with compliance investigations
• Recent experience with revenue cycle or project management

Sound Physicians is an Equal Employment Opportunity (EEO) employer and is committed to diversity, equity, and inclusion at the bedside and in our workforce.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, gender identity, sexual orientation, age, marital status, veteran status, disability status, or any other characteristic protected by federal, state, or local laws.

This job description reflects the present requirements of the position. As duties and responsibilities change and develop, the job description will be reviewed and subject to amendment.