Healthcare Compliance Specialist

Health Care Compliance Specialist

VIP Community Services, an important anchor in the Bronx community serving adults with serious substance use addictions, is seeking a Health Care Compliance Specialist to join the Compliance Department. The Compliance Department is an integral part of VIP's mission and operations. VIP Community Services is committed to providing its clients with high quality and caring services pursuant to the highest ethical and legal standards. The department was developed to ensure this. The department's mission is to help support VIP's direct care and support programs by developing and facilitating processes and systems that ensure compliance with all health care compliance regulatory standards.

The Health Care Compliance Specialist reports to the Chief Compliance Officer (CCO). This position will work closely with VIP's residential and supportive housing, outpatient, health homes, health services, and substance use programs.

Specific Duties and Tasks: include but are not limited to the following:

• Responsible for conducting audits of medical records to determine whether services provided to patients are appropriately documented and billed in accordance with Medicare, Medicaid and third party billing regulations and/or standards.
• Prepare written reports that summarize medical record review findings for CCO review.
• Provides in-services and educational materials on subjects pertinent to audits conducted, and any coding and billing changes to appropriate staff.
• Conduct program compliance audits
• Conduct risk assessments
• Conduct compliance investigations on formal complaints and allegations and prepare investigation reports
• Develop and implement assessment/audit tools
• Assist CCO in investigating inquiries which may relate to erroneous billing and coding of services.
• Manage agency chart requests and accounting process
• Assist in the development and revision of compliance and privacy training materials
• Facilitate Compliance and Privacy trainings
• Manage agency vendor-DRA compliance correspondence
• Review regulatory websites for updates
• Participate in quarterly Audit Committee meetings, agency Compliance Committee
• Assist in the management of the agency's chart retention and destruction process
• Develop and maintain audit review schedules for all agency departments
• Make recommendations and develop tools to support program improvement
• Recommend quality improvement projects and trainings based on data trends
• Gather, review and analyze data collected from audits and prepare audit reports for program and executive leadership review
• Read and apply regulations and laws
• Participate in agency-wide quality improvement initiatives
• Create and maintain meeting minutes and agendas repository for compliance meetings
• Work closely with department directors to develop and implement compliance activities
• Participate in the development and implementation of compliance policies in conjunction with senior department staff
• Perform all related clerical and administrative duties
• Represent the department and agency in internal and external meetings as needed
• Summarize monthly compliance activities on the spread sheet report.
• Other duties as assigned

Educational/Training Required: (List all that is required to achieve this position):

• Bachelor's Degree required, Master's Degree preferred; CHC or CHPC certification preferred

Experience Required/Language Preference (List what the desire to reach goals):

• Minimum of three years of experience working in the healthcare industry and compliance: mental health and substance use field, (residential experience a plus), conducting Medicaid/Medicare audits and conducting compliance investigations
• Superb writing, assessment, planning and analytical skills
• Ability to facilitate trainings
• Knowledge and experience with data collection and synthesis into comprehensive reports
• Exemplary attention to details
• Knowledgeable of OMH, DOHMH, OASAS and DHS, OTDA, HRSA, CCBHC regulations, including billing standards is preferred
• Knowledge of compliance regulatory standards and laws: Mandatory Compliance Regulations (Part 521), Federal False Claims Act, Healthcare Fraud Statute, Anti-Kickback Laws,
• Knowledge of Privacy regulations (State, HIPAA, HIV Confidentiality Laws (PHL 27-F) and Substance Use Privacy Laws (42 CFR Part 2)

Computer Skills Required (List the computer skills needed):

• Master of Microsoft Office Suite; Advanced knowledge of utilizing EHRs/EMRs: AWARDS, AVATAR, and ECW; Familiar with NIMRS

Visual and Manual Dexterity:

• The candidate should be able to read documents for analytical purposes such as computer information, software, reports, etc.
• Limited applications of manual dexterity and hand-eye coordination.

Work Environment / Physical Effort:

• The work environment involves no physical risk or hazardous conditions.
• To perform the essential functions of this job, the candidate is routinely required to sit, stand, walk, reach with hands and arms, talk, hear, and use both close and distance vision. (Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.)