Senior Compliance Analyst

Compliance Analyst

Reporting to the Chief Compliance Officer, the Compliance Analyst's primary role is to assess and monitor St. Charles Health System activities for compliance with applicable laws, regulations, ethical standards, and system policies and procedures. The compliance analyst is an experienced professional who develops and disseminates comprehensive resources, education and training programs, and coordinates activities to support compliance and operational policies and procedures. This position does not directly manage other caregivers, however, may be asked to review and provide feedback on the work of other caregivers.

Essential functions and duties include:

• Monitoring and interpreting federal, state, and local healthcare laws and regulations to ensure St. Charles Health System compliance.
• Maintaining knowledge of St. Charles Health System policies, procedures, and organizational standards and processes that support the seven elements of an effective compliance program as defined by the Office of the Inspector General.
• Serving as a collaborative resource to St. Charles Health System leadership, employees, and medical staff on compliance-related topics and issues.
• Identifying compliance risk through a collaborative risk assessment process with key stakeholders.
• Receiving, triaging, and disseminating compliance-related notifications received from CMS, OHA, OCR, HRSA, and OIG.
• Supporting the organizational response to those compliance-related notices as requested by the Chief Compliance Officer.
• Assisting in responding to regulatory investigations and periodic payor audits and assessments.
• Investigating and responding to reports of legal, regulatory, or policy violations and other compliance concerns received from St. Charles Health System caregivers and others.
• Working with leadership to recommend and establish policies and procedures to address legal, regulatory, and other compliance related matters.
• Championing compliance as a core business principle and empowering caregivers and providers to speak up and do the right thing.
• Identifying, and monitoring, compliance trends and themes in data from complaint-driven investigations, routine and targeted audits, and related reports.
• Participating in and serving on St. Charles Health System committees, collaborating with business, operational, legal and compliance stakeholders, and supporting all compliance related processes and activities.
• Creating and maintaining appropriate documentation of all compliance activities.
• Providing system level leadership to establish and maintain open lines of communication within the organization to encourage the prompt reporting of compliance concerns.
• Developing, executing, and managing detailed project plans and status reports.
• Serving as the Revenue Integrity & refund liaison.
• Supporting the vision, mission, and values of the organization in all respects.
• Supporting the Lean principles of continuous improvement with energy and enthusiasm, functioning as a champion of change.
• Providing and maintaining a safe environment for caregivers, patients, and guests.
• Conducting all activities with the highest standards of professionalism and confidentiality.
• Complying with all applicable laws, regulations, policies, and procedures, supporting the organization's corporate integrity efforts by acting in an ethical and appropriate manner, reporting known or suspected violation of applicable rules, and cooperating fully with all organizational investigations and proceedings.
• Delivering customer service and/or patient care in a manner that promotes goodwill, is timely, efficient, and accurate.

Education: Required: Bachelor's degree in a Health Science, Business, Nursing, Health Information Management, or related field. Required: Healthcare Compliance or equivalent Compliance Certification (ex. CHC, CHRC, CHPC, CHC-F, or CCEP). Valid Oregon driver's license and ability to meet St. Charles Health System driving requirements. Ability to travel to business functions/trainings/meetings and all St. Charles Health System worksites.

Experience: Required: Minimum five (5) years experience working in healthcare compliance. Demonstrable legal research skills, with particular knowledge regarding state and federal statutory and regulatory law. Experience working with Current Procedural Terminology (CPT) and related coding nomenclature and rules, ICD-10-CM coding conventions, and clinical documentation standards. At least two (2) years' experience working directly with physicians on professional fee billing compliance.