Senior Compliance Specialist

Senior Compliance Specialist

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation's largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 158 hospital-based locations, in addition to its home-based services and virtual care offerings.

As our Senior Compliance Specialist, you will support the CommonSpirit Health Corporate Responsibility Program by developing, implementing, and maintaining an effective and comprehensive compliance auditing and monitoring program. Every day you will conduct and facilitate compliance audits for acute and non-acute care services, analyze outcomes, communicate findings, and contribute to the ongoing auditing and monitoring efforts across CommonSpirit Health to ensure regulatory adherence. To be successful in this role, you will possess strong analytical and auditing skills, a deep understanding of healthcare compliance regulations, and the ability to effectively communicate findings and proactively support the continuous improvement of our compliance program.

• Supports CRP leadership in developing, implementing and maintaining the compliance monitoring/auditing work plan. Primary reviews/audits will be focused on coding and medical necessity documentation guidelines. Determines monitoring/auditing procedures to be used including the use of computer-assisted audit techniques.
• In conjunction with clinical services and other functional groups, utilizes data analytics to develop and assess coding and clinical outlier risks. Monitors government recovery audit efforts for trends and patterns of non-compliance with billing, medical necessity and coding issues affecting acute and non-acute care services.
• Works closely with Health Information Management (HIM), revenue cycle, legal services group, advocacy and other applicable functional areas to ensure proper interpretation, dissemination and ongoing internal auditing and monitoring of compliance with laws and regulations related to coding compliance and medical necessity.
• Supports leadership in the development, implementation, maintenance, and evaluation of policies, procedures, tools and templates to address changes in current laws and regulations and/or revisions to current laws and regulations related to coding compliance and medical necessity.
• Develops education designed to promote understanding of coding compliance and medical necessity issues, laws and regulations and consequences of noncompliance.
• Analyzes reports, data, and trends to keep management and governance informed of the current regulatory environment impacting coding and medical necessity compliance and the potential impact to CommonSpirit Health.

Required: Bachelors Of Science Nursing or Equivalent experience may be considered in lieu of degree. 5 years progressive experience in healthcare operations including clinical, regulatory compliance, risk management, audit, law, or related field. Certified Health Care Compliance (CHC). Registered Health Information Technician (RHIT). Registered Health Information Administrator (RHIA). Certified Coding Specialist - Physician Based (CCS-P). Certified Coding Specialist (CCS).