Compliance Specialist

Job Description

Job Description

University of Toledo Physicians' mission is to improve the human condition through excellence in patient care and medical discovery. Representing more than 200 physicians, UT Physicians are leaders in clinical care, research and education of the future physicians, providing care in a wide range of medical specialties from the most complex diagnoses and treatments to primary care for the entire family. The primary site of inpatient care services is at the University of Toledo Medical Center, but many of our physicians’ practice at hospitals and medical offices throughout the region.

University of Toledo Physicians offers competitive pay and benefits including: 403B, Pension, health and tuition waiver at UT.

Summary

The Compliance Specialist supports UToledo Health’s commitment to ethical conduct, regulatory compliance, and risk management. This role plays a key part in developing, implementing, and monitoring the healthcare compliance program to ensure alignment with federal and state regulations, internal policies, and applicable hospital standards, including but not limited to, hospital Conditions of Participation and Conditions of Payment.

1. Investigations: support the intake, lead the investigation, and ensure proper documentation of compliance concerns or potential violations, ensuring timely resolution and appropriate follow-up.
2. Monitor Regulatory Compliance: by ensuring organizational adherence to federal and state healthcare regulations.
3. Education and Training: deliver or coordinate compliance training for UToledo workforce to promote awareness and understanding of regulatory requirements.
4. Support Risk Assessments: Participate in risk evaluations and assist in prioritizing compliance focus areas based on investigations, external audit findings, and regulatory updates.
5. Conduct Audits and Reviews: Conduct routine and targeted audits of clinical billing and operational workflows to identify compliance risks and provide recommendations for corrective action.
6. Collaborate with Departments: Collaborate with clinical, administrative, and operational teams to advance compliance initiatives and integrate best practices across department workflows.
7. Policy and Procedure Support: assist in the development, review, and implementation of compliance-related policies and procedures across departments.
8. Maintain Documentation: keep accurate records of audits, investigations, training, and other compliance activities for internal tracking and external reporting.
9. Other duties as assigned

Education:

*A bachelor’s degree in healthcare administration, health information management, compliance, or a related field is required. Alternatively, a combination of education and relevant experience- such as roles in coding or billing compliance- may also be considered.

Experience:

*Minimum of one to two (1-2) years of experience in healthcare compliance, auditing, coding, or regulatory affairs within a hospital or health system setting is required.

*Familiarity with healthcare laws, regulations, and compliance frameworks.

Certification:

*Certified in Healthcare Compliance (CHC) or willingness to obtain within twelve (12) months of hire preferred

Knowledge and Skills:

*Strong understanding of healthcare regulations, including but not limited to, CMS Conditions of Participation and Payment, and OIG compliance guidance.

*Familiarity with billing, coding, and documentation standards.

*Ability to conduct audits, analyze data, and identify compliance risks.

*Excellent written and verbal communication skills.

*Strong attention to detail and organizational skills.

*Ability to work independently and collaboratively across departments.

*Proficiency in Microsoft Office and compliance-related software tools.

Reporting Relationships

*Reports directly to the Director of Healthcare Compliance. This role also maintains indirect reporting relationships with leadership at both UTMC (University of Toledo Medical Center) and UTP (University of Toledo Physicians) to support alignment across the health system.

*No positions report to this role.

Working Conditions

*This position is onsite and requires regular presence at UToledo Health facilities.

*Must have the ability to travel between multiple locations within the health system as needed to support compliance activities.

*Standard business hours apply, with occasional flexibility required to meet project deadlines or attend training sessions.

*May involve prolonged periods of sitting, computer use, and interaction with clinical and administrative staff.

The above list of duties is intended to describe the general nature and level of work performed by people assigned to this classification. It is not intended to be construed as an exhaustive list of duties performed by the people so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct and control the work of employees under his/her supervision.

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity or gender expression, age, disability, military or veteran status, height, weight, familial or marital status, or genetics.

Equal Opportunity Employer/Drug-Free Workplace